Standard versus mini amplatz size in patients undergoing pediatric percutaneous nephrolithotomy through 16 years of experience: A retrospective study in single-center experience

Abstract

Background: Pediatric urolithiasis is associated with considerable morbidity and a very high recurrence rate of approximately 67%. Current guideline recommendations for standard pediatric percutaneous nephrolithotomy (PCNL) remain a problem due to several complications, such as hemorrhage or renal damage, especially in the pediatric population. However, mini-PCNL is regarded as a safer and more effective method for pediatric patients. This study compares PCNL with mini-PCNL, along with their efficacy and safety, in the Cipto Mangunkusumo General Hospital, Indonesia. Methods: This observational retrospective study was performed on pediatric patients aged < 18 years (pediatric patients) who underwent PCNL with a standard 22-30 Fr sheath or mini 15-21 Fr sheath. We reviewed postoperative outcomes, including stone-free rate (SFR), presence of complications, and postoperative drainage method. Data analysis was performed using SPSS version 26.0. Results: Our study included a total of 42 pediatric patients (mean age: standard, 4.61 ± 3.52 years; mini, 8.0 ± 3.57 years; p<0.05). The stone-free rate was significantly higher in the mini-PCNL group (87.9%) than in the standard PCNL group (59.1%, p <0.05). All patients treated with mini-PCNL were tubeless, while some patients in the standard group still needed a postoperative drainage tube (p=0.012). Complications, such as infundibulum laceration, were rare, and their differences between groups insignificant (p=1). Even though it has been demonstrated that standard sheath PCNL is considered effective for children, smaller PCNL sheaths offers more experience. Mini-PCNL provides a similar complication rate, while remaining effective in treating urolithiasis; thus, it is thought to be a non-inferior option for treating pediatric populations, especially younger and smaller children. Conclusions: Mini-PCNL is non-inferior to standard PCNL in terms of efficacy and safety for the treatment of pediatric urolithiasis. Mini-PCNL resulted in higher SFR and totally tubeless follow-up.