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Assesment of factors affecting outcome of Mini-PCNL by single-shot dilatation in Pediatric Patients
Kadir Emre Baltaci1, Berk Hazir2, Mesut Altan2
1Hacettepe University Hospital, Ankara, Turkey. kadiremrebaltaci@gmail.com.
Insights
Mini-Percutaneous Nephrolithotomy (Mini-PCNL) is a safe and effective pediatric stone removal technique with an 80.6% stone-free rate. However, prior PCNL history and larger stone burden reduce success rates.
Area of Science:
- Pediatric Urology
- Nephrolithiasis Management
- Minimally Invasive Surgery
Background:
- Pediatric stone disease prevalence is rising, demanding pediatric-specific surgical instruments.
- Mini-Percutaneous Nephrolithotomy (Mini-PCNL) offers a solution for smaller anatomical structures.
Purpose of the Study:
- To evaluate the safety and efficacy of Mini-PCNL in pediatric patients.
- To identify factors influencing surgical success and complications in pediatric Mini-PCNL.
Main Methods:
- Retrospective analysis of 72 pediatric renal units undergoing Mini-PCNL (≤17.5F).
- Statistical analysis (univariate and multivariate) to determine predictors of stone-free status and complications.
Main Results:
- Overall stone-free rate was 80.6% with a 22.2% complication rate.
- Factors associated with lower success included prior PCNL history and stone burden ≥2 cm².
- No single predictive factor for complications was identified.
Conclusions:
- Mini-PCNL is a safe and effective procedure for pediatric stone removal.
- Lower success rates in patients with prior PCNL or large stone burden necessitate careful consideration.
- Cystine stones may require more intensive treatment for complete clearance.
Objectives:
The prevalence of stone disease in children is increasing, necessitating approaches using instruments of more suitable sizes for surgical treatment. We aim to convey our experience with Mini-PCNL.
Materials And Methods:
We retrospectively analyzed a total of 72 renal units that underwent single-shot dilatation Mini-PCNL(≤ 17.5F) between August 2017 and November 2024. Univariate and multivariate analyses were used to assess the factors for surgical success (no postoperative residual) and complications.
Results:
Medians for our cohort were age at surgery was 5.5 years, operation time was 120 min, hospitalization time was 5 days, stone size was 2.04 cm2. Overall SFR was 80.6%. We observed complications in 16 patients(%22.2). In univariate analysis; HU < 820, PCNL history, cystine stone, stone burden > 2 cm2 and stone length > 29 mm were found to be associated with lower success. In the multivariate analysis results, patients with a previous history of PCNL (56% vs 93.6%) (p = 0.005) and patients with a stone burden ≥ 2 cm2 (68.4% vs 94.1%) (p = 0.021) were found to be associated with less successful results. Univariate analysis revealed no single predictive factor for complication development.
Conclusion:
Mini-PCNL is a surgical method that can be performed safely in the pediatric age group due to its high stone-free rate. However, it should be kept in mind that the success rates are lower in those with a history of PCNL due to anatomical challenges secondary to previous surgeries and with high stone burden. Patients with cystine stones deserve more effort to make them free of fragments.