Is Mini Percutaneous Nephrolithotomy a Game Changer for the Treatment of Renal Stones in Children?

ABSTRACT

BACKGROUND: Mini percutaneous nephrolithotomy (MPCNL) is a newer surgical procedure that has changed the management of paediatric renal stones. OBJECTIVE: To evaluate MPCNL morbidity and success rates for renal stones as a function of patient age in a paediatric cohort. DESIGN SETTING AND PARTICIPANTS: This was a retrospective case series that included 143 consecutive patients younger than 17 yr who underwent MPCNL at our institution between January 2016 and November 2020. The patients were categorised into three different age groups <6 yr (n = 71, 49.7%), 6-11 yr (n = 44, 30.8%), and 12-17 yr (n = 28, 19.6%). MPCNL was performed in all patients through 16-20Fr tracts. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The stone-free rate, perioperative complications, tract number, operative time, postoperative haemoglobin change, and hospitalisation time were evaluated for each age group. RESULTS AND LIMITATIONS: MPCNL was performed in 143 paediatric patients (88 boys and 55 girls; mean age 6.53 yr). The mean stone burden (± standard deviation) was 2.096 ± 1.01 cm in group one, 2.05 ± 1.05 cm in group two, and 3.46 ± 19.94 cm in group three; group three was significantly larger (p = 0.001). After a single MPCNL session, 92.42% of patients experienced complete stone clearance. All age groups were similar in terms of stone-free rate (p = 0.82), hospitalisation time (p = 0.94), postoperative haemoglobin change (p = 0.06), and perioperative complications (p = 0.62). However, stone size (p = 0.009), stone complexity (p = 0.001), number of access points (p = 0.03), and operative time (p = 0.009) were higher in the group aged 12-17 yr. CONCLUSIONS: MPCNL is an effective and safe procedure in younger as well as older children. Age should not be considered a limiting factor for MPCNL in children, and MPCNL should be considered the primary option for treating paediatric renal stones when PCNL is indicated. PATIENT SUMMARY: Our results show that surgical removal of kidney stones through an incision in the skin and using miniaturised instruments is an effective and safe procedure for children.