Supine mini-PCNL using pneumatic lithotripsy for pediatric renal stones: safety and efficacy in low-income countries

Mini-percutaneous nephrolithotomy (mini-PCNL) is an effective surgical technique for pediatric renal stones. However, data comparing different lithotripsy modalities in this population are limited.

To compare the efficacy, safety, and acute renal parenchymal impact of pneumatic lithotripsy versus Holmium: YAG (Ho: YAG) laser dusting during supine mini-percutaneous nephrolithotomy (mini-PCNL) in pediatric patients.

A double-masked, randomized clinical trial was conducted between March 2023 and October 2024. A total of 104 pediatric patients (ages 3-10 years) with solitary renal stones (10-25 mm) were randomized into two groups: Group 1 (n = 53) underwent mini-PCNL using a pneumatic lithotripter, and Group 2 (n = 51) underwent mini-PCNL using Ho: YAG laser dusting. Primary outcomes included operative time, stone-free rate (SFR), complications (Clavien-Dindo), and biochemical markers of renal injury, including Kidney Injury Molecule-1 (KIM-1) and albumin/creatinine (A/C) ratio.

Pneumatic lithotripsy demonstrated significantly shorter mean operative times (59.5 vs. 67.6 min, p = 0.007) and lithotripsy times (p < 0.001) compared to the laser group. The stone-free rates were comparable between the pneumatic and laser groups (92.45% vs. 94.1%, p > 0.05). Group 1 (pneumatic) had a significantly shorter hospital stay (2.2 vs. 2.6 days, p = 0.004). While both groups showed postoperative elevations in injury markers, the laser group exhibited significantly higher and more sustained levels of urinary KIM-1 and A/C ratios, as well as higher postoperative RBC counts in nephrostomy samples (p < 0.05). No major complications or perforations occurred in either group.

Pneumatic lithotripsy is a highly effective and safe alternative to laser lithotripsy for pediatric mini-PCNL. It offers comparable operative efficiency, reduced hospital stays, and potentially lower acute tubular injury as evidenced by lower KIM-1 levels. Given its lower cost and comparable stone-free rates, pneumatic lithotripsy is a favorable option for managing pediatric renal stones in resource-conscious settings.