Which surgical method should be used in pediatric patients with a solitary kidney and 1-2 cm kidney stones?

To evaluate and compare the efficacy and safety of retrograde intrarenal surgery (RIRS) and Mini-percutaneous nephrolithotomy (PCNL) in treating pediatric patients with solitary kidneys harboring medium-sized (1-2 cm) kidney stones.

This study was conducted retrospectively. The two groups were compared in terms of surgical and postoperative parameters. Renal function was assessed both preoperatively and at the third month following surgery.

The mean age of patients in the mini-PCNL group was 13.5 ± 3.6 years, whereas that in the RIRS group was 10.7 ± 3.9 years (p = 0.772). The duration of fluoroscopy was significantly longer in the mini-PCNL group (126 ± 46.8 s) than in the RIRS group (55.3 ± 32.6 s) (p < 0.001). Conversely, the RIRS group had a longer operative time (58.3 ± 28.1 min) than did the mini-PCNL group (40.4 ± 19.2 min) (p = 0.028). At the one-month follow-up, stone-free rates were markedly higher in the mini-PCNL group (97.5%) than in the RIRS group (80.6%) (p < 0.001). There was no significant change in renal function following both surgeries.

Mini-PCNL demonstrated superior outcomes in terms of stone clearance, reduced operative duration, and a lower need for subsequent procedures. In contrast, RIRS was associated with reduced fluoroscopy exposure and minimal blood loss, although it necessitated more frequent use of supplementary interventions.