Bilateral Single-session PCNL with Minimally Invasive Technique in Pediatric Complex Nephrolithiasis

Abstract

Abstract Objectives To assess outcomes of bilateral single-session percutaneous nephrolithotomy (PCNL) with minimally invasive technique in pediatric population. Patients and methods Children who were treated with minimally invasive bilateral single-session PCNL from August 2015 to July 2021 were analyzed. Minimally invasive PCNL in this study included miniPCNL (12-16-Fr) and Microperc (4.8-Fr). Patient demographics, stone and operative characteristics, stone-free rate (SFR) and complication rate (CR) were detailed and compared. Independent predictors for operation time, irrigated fluid volume, postoperative hospital stay and postoperative complication were determined. Results Forty-five children (including 12 infants) with mean stone burden of 3.2 cm were enrolled, among whom the male-to-female ratio was nearly 1.5:1. SFR was 93.3% and overall CR was 53.3% (Clavien grade 1 + 2, 46.7%). SFR were favourable with different sizes of PCNL. Self-limiting hematuria represented the most common complication (33.3%), especially with miniPCNL. Stone burden was the only independent predictor for operation time (p<0.001) and postoperative complication (p = 0.008). Children with older age (p = 0.009), higher body mass index (p = 0.016) or higher stone burden (p<0.001) received larger irrigated fluid volume. Microperc was associated with less irrigated fluid volume (p = 0.001). Children with overall complications (p<0.001), especially Clavien grade 3 complications (p = 0.004) spent prolonged postoperative hospital stay. Conclusion Bilateral-Microperc was a preferred option for children with lower stone burden or younger children. Bilateral single-session PCNL is a feasible, effective and safe procedure for pediatric complex nephrolithiasis, and it could be a surgical option for experienced urologists.