Mini Vs Standart Pnl in the Management of Complex Renal Stones in Children: is the Role of Standard Pnl Over?

Abstract

Abstract Aim To evaluate the efficacy and safety of Mini vs Standard PNL in the management of large calculi in children. Patients and Methods: A total of 64 pediatric cases with large stones underwent either mini-PNL (Group 1, n = 42) or standard PNL procedure (Group 2, n = 22) for the minimal invasive management of these calculi. Pre-intra and post operative data were analyzed in a comparative manner. Results A total of 64 children (40 boys, 24 girls) with an overall mean age 9.78 ± 4.2 months were included in this study. The overall mean burden of the stones was 168.64 ± 14.4 mm2. While a 17 Fr rigid pediatric nephroscope with a laser or pneumatic intracorporeal lithotripsy were used through 20–22 Fr sheath for mini PNL procedure, 26 Fr nephroscope with a pneumatic intracorporeal lithotripsy were used through 30 Fr sheath for standard PNL procedures. Stone-free rates were 88.1% and 86.3% in Group 1 and 2 respectively after 1 day. Mean operative time was similar in both groups and average hospitalization time was longer in cases undergoing standard-PNL. While the mean hemoglobin drop was 0.52 ± 0.1 g/dl in Group 1, this value was 1.34 ± 0.4 g/dl in standard PNL group. No major complication was observed in both groups. Conclusions Although pediatric miniaturized PNL systems are performed with safe and effective outcomes with complex stones; standard PNL may also be a rational option in selected cases where these systems and expertise are not available. Additionally number of punctures could be limited with the application of large bore tracts.