Comparison of two percutaneous nephrolithotomy methods for the treatment of pediatric kidney stones: Mini-PCNL and standard PCNL

Kadir Karkin; Mubariz Aydamirov; Buğra Aksay; Eyüp Kaplan; Güçlü Gürlen; Adem Altunkol; Ferhat Ortaoğlu; Ömer Faruk Akgün; Ediz Vuruşkan; Zafer Gökhan Gürbüz

doi:10.4081/aiua.2024.12369

Authors

Kadir Karkin
kadir_karkin@msn.com
Health Sciences University, Adana City Training and Research Hospital Urology Clinic, Adana, Turkey. https://orcid.org/0000-0002-4324-3032
Mubariz Aydamirov Başkent University, Alanya Application and Research Center, Alanya, Turkey. https://orcid.org/0000-0002-7197-3585
Buğra Aksay Health Sciences University, Adana City Training and Research Hospital Urology Clinic, Adana, Turkey.
Eyüp Kaplan Abdulkadir Yüksel State Hospital Urology Clinic, Gaziantep, Turkey.
Güçlü Gürlen Health Sciences University, Adana City Training and Research Hospital Urology Clinic, Adana, Turkey.
Adem Altunkol Health Sciences University, Adana City Training and Research Hospital Urology Clinic, Adana, Turkey.
Ferhat Ortaoğlu Health Sciences University, Adana City Training and Research Hospital Urology Clinic, Adana, Turkey.
Ömer Faruk Akgün Health Sciences University, Adana City Training and Research Hospital Urology Clinic, Adana, Turkey.
Ediz Vuruşkan Health Sciences University, Adana City Training and Research Hospital Urology Clinic, Adana, Turkey.
Zafer Gökhan Gürbüz Health Sciences University, Adana City Training and Research Hospital Urology Clinic, Adana, Turkey.

Objective: In this study, the aim was to compare the results of mini and standard percutaneous nephrolithotomy (PCNL) for the treatment of pediatric kidney stones.

Materials and Methods: Data for 128 patients < 18 years of age who underwent mini and standard PCNL due to pediatric kidney stones were retrospectively examined. Patients were divided into two groups: mini-PCNL (16-20 Fr) and standard PCNL (26 Fr). Surgery time, number of punctures to the pelvicalyceal system, hospital stay, postoperative hemoglobin drop, complications and stone-free status (SFR) were compared between the groups. Additional surgical intervention (double-J stent, ureterorenoscopy, secondary PCNL) performed after the surgery was recorded. The absence of residual stones or < 3 mm residual stones on kidney, ureter and bladder radiography (KUB) and ultrasonography (USG) performed in the third postoperative month were accepted as success criteria.

Results: There were 32 (43.8%) patients in the mini-PCNL group and 41 (56.2%) patients in the standard PCNL group. The mean age was 9.3 ± 4.1 years in the mini-PCNL group and 10.1 ± 5.4 years in the standard PCNL group. Mean stone size in the mini-PCNL group was 2.1 ± 1.2; while for standard PCNL it was 2.3 ± 1.4. The mean surgery time was statistically significantly higher in the mini-PCNL group (p = 0.005). There was no difference between the groups in terms of intraoperative double J stent use, postoperative complications and SFR. A double J stent was inserted in two patients in the mini-PCNL group and in one patient in the standard PCNL group due to urine leakage from the nephrostomy tract in the postoperative period. Although the postoperative hemoglobin drop was found to be significantly higher in standard PCNL (p = 0.001), hematuria and blood transfusion rates were low in both groups. Mean hospital stay was shorter in the mini-PCNL group compared to standard PCNL (3.6 ± 1.2 days vs. 2.5 ± 1.1; p = 0.018).

Conclusions: Although mini-PCNL has longer surgery time compared to standard PCNL, it should be preferred for the treatment of pediatric kidney stones due to advantages such as similar success and complication rates to standard PCNL, short hospital stay and less postoperative hemoglobin drop.

Smaldone MC, Docimo SG, Ost MC. Contemporary surgical management of pediatric urolithiasis. Urol Clin North Am. 2010;37:253-67. DOI: https://doi.org/10.1016/j.ucl.2010.03.006

Veeratterapillay R, Shaw MB, Williams R, et al. Safety and efficacy of percutaneous nephrolithotomy for the treatment of paediatric urolithiasis. Ann R Coll Surg Engl. 2012; 94:588-92. DOI: https://doi.org/10.1308/003588412X13373405387014

Tekgül S, Stein R, Bogaert G, et al. European Association of Urology and European Society for Paediatric Urology Guidelines on Paediatric Urinary Stone Disease. Eur Urol Focus. 2022; 8:833-39. DOI: https://doi.org/10.1016/j.euf.2021.05.006

Zeren S, Satar N, Bayazit Y, et al. Percutaneous nephrolithotomy in the management of pediatric renal calculi. J Endourol. 2002; 16:75-8. DOI: https://doi.org/10.1089/089277902753619546

Guven S, Istanbulluoglu O, Gul U, et al. Successful percutaneous nephrolithotomy in children: multicenter study on current status of its use, efficacy and complications using Clavien classification. J Urol. 2011; 185:1419-24. DOI: https://doi.org/10.1016/j.juro.2010.11.055

Onal B, Dogan HS, Satar N, et al. Factors affecting complication rates of percutaneous nephrolithotomy in children: results of a multiinstitutional retrospective analysis by the Turkish pediatric urology society. J Urol. 2014; 191:777-82. DOI: https://doi.org/10.1016/j.juro.2013.09.061

Kapoor R, Solanki F, Singhania P, et al. Safety and efficacy of percutaneous nephrolithotomy in the pediatric population. J Endourol. 2008; 22:637-40. DOI: https://doi.org/10.1089/end.2007.0254

Hesse A, Brändle E, Wilbert D, et al. Study on the prevalence and incidence of urolithiasis in Germany comparing the years 1979 vs. 2000. Eur Urol. 2003; 44:709-13. DOI: https://doi.org/10.1016/S0302-2838(03)00415-9

Samad L, Aquil S, Zaidi Z. Paediatric percutaneous nephrolithotomy: setting new frontiers. BJU Int. 2006; 97:359-63. DOI: https://doi.org/10.1111/j.1464-410X.2006.05932.x

Jackman SV, Hedican SP, Peters CA, et al. Percutaneous nephrolithotomy in infants and preschool age children: experience with a new technique. Urology. 1998; 52:697-701. DOI: https://doi.org/10.1016/S0090-4295(98)00315-X

Dogan B, Atmaca AF, Canda AE, et al. Efficiency of percutaneous nephrolithotomy in pediatric patients using adult-type instruments. Urol Res. 2012; 40:259-62. DOI: https://doi.org/10.1007/s00240-011-0408-4

Salah MA, Tóth C, Khan AM, et al. Percutaneous nephrolithotomy in children: experience with 138 cases in a developing country. World J Urol. 2004; 22:277-80. DOI: https://doi.org/10.1007/s00345-004-0454-4

Unsal A, Resorlu B, Kara C, et al. Safety and efficacy of percutaneous nephrolithotomy in infants, preschool age, and older children with different sizes of instruments. Urology. 2010; 76:247-52. DOI: https://doi.org/10.1016/j.urology.2009.08.087

Goyal NK, Goel A, Sankhwar SN, et al. A critical appraisal of complications of percutaneous nephrolithotomy in paediatric patients using adult instruments. BJU Int. 2014; 113:801-10. DOI: https://doi.org/10.1111/bju.12506

Mahmood SN, Aziz BO, Tawfeeq HM, et al. Mini- versus standard percutaneous nephrolithotomy for treatment of pediatric renal stones: is smaller enough? J Pediatr Urol. 2019; 15:664.e1-664.e6. DOI: https://doi.org/10.1016/j.jpurol.2019.09.009

Mahajan AD, Mahajan SA. Comparison of Mini-Percutaneous Nephrolithotomy by Standard and Miniperc Instruments in Pediatric Population: A Single-Center Experience. J Pediatr Urol. 2021; 26:374-79. DOI: https://doi.org/10.4103/jiaps.JIAPS_212_20

Kumar N, Yadav P, Kaushik VN, et al. Mini-versus standard percutaneous nephrolithotomy in pediatric population: A randomized controlled trial. J Pediatr Urol. 2023; 19:688-95. DOI: https://doi.org/10.1016/j.jpurol.2023.08.013

Bilen CY, Koçak B, Kitirci G, et al. Percutaneous nephrolithotomy in children: lessons learned in 5 years at a single institution. J Urol. 2007; 177:1867-71. DOI: https://doi.org/10.1016/j.juro.2007.01.052

Celik H, Camtosun A, Dede O, et al. Comparison of the results of pediatric percutaneous nephrolithotomy with different sized instruments. Urolithiasis. 2017; 45:203-208. DOI: https://doi.org/10.1007/s00240-016-0887-4

Altintas R, Oguz F, Tasdemir C, et al. The importance of instrument type in paediatric percutaneous nephrolithotomy. Urolithiasis. 2014; 42:149-153. DOI: https://doi.org/10.1007/s00240-013-0626-z

Ozden E, Mercimek MN, Yakupoglu YK, et al. Modified Clavien classification in percutaneous nephrolithotomy: assessment of complications in children. J Urol. 2011; 185:264-68. DOI: https://doi.org/10.1016/j.juro.2010.09.023

Zeng G, Zhao Z, Zhao Z, et al. Percutaneous nephrolithotomy in infants: evaluation of a single-center experience. Urology. 2012; 80:408-11. DOI: https://doi.org/10.1016/j.urology.2012.04.058

Resorlu B, Unsal A, Tepeler A, et al. Comparison of retrograde intrarenal surgery and mini-percutaneous nephrolithotomy in children with moderate-size kidney stones: results of multi-institutional analysis. Urology. 2012; 80:519-23. DOI: https://doi.org/10.1016/j.urology.2012.04.018

Yan X, Al-Hayek S, Gan W, et al. Minimally invasive percutaneous nephrolithotomy in preschool age children with kidney calculi (including stones induced by melamine-contaminated milk powder). Pediatr Surg Int. 2012; 28:1021-24. DOI: https://doi.org/10.1007/s00383-012-3112-8

Izol V, Satar N, Bayazit Y, et al. Which factors affect the success of pediatric PCNL? Single center experience over 20 years. Arch Ital Urol Androl. 2020; 18:345-49. DOI: https://doi.org/10.4081/aiua.2020.4.345

Eslahi A, Ahmed F, Hosseini MM, et al. Minimal invasive percutaneous nephrolithotomy (Mini-PCNL) in children: Ultrasound versus fluoroscopic guidance. Arch Ital Urol Androl. 2021; 28:173-77. DOI: https://doi.org/10.4081/aiua.2021.2.173

Karkin, K., Aydamirov, M., Aksay, B., Kaplan, E., Gürlen, G., Altunkol, A., Ortaoğlu, F., Akgün, Ömer F., Vuruşkan, E., & Gürbüz, Z. G. (2024). Comparison of two percutaneous nephrolithotomy methods for the treatment of pediatric kidney stones: Mini-PCNL and standard PCNL. Archivio Italiano Di Urologia E Andrologia. https://doi.org/10.4081/aiua.2024.12369