Mini-PCNL Safe and Effective for Treating Kidney Stones in Children: Study Reveals

The study found that mini-PCNL is safe and achieves a high stone-free rate, making it an appealing choice for patients and healthcare providers.

"In patients with stones larger than 15 mm, the stone-free rate was 87.01%, comparable to the 88.57% observed in adults. Although adults experienced a slightly greater drop in hemoglobin levels, there were no significant differences in complications, including blood transfusions, postoperative fever, or the need for additional interventions," the researchers wrote.

Mini-PCNL is a refined version of traditional percutaneous nephrolithotomy (PCNL), designed specifically for children. It employs smaller instruments and accesses the kidney through a tiny incision, reducing tissue damage and recovery time. Waleed N. Jaffal, College of Medicine, University of Anbar, Ramadi, Al Anbar, Iraq, and colleagues aimed to evaluate the safety and efficacy of mini-PCNL for treating renal stones in children.

For this purpose, the researchers enrolled 77 patients under the age of 15 with renal stones larger than 15 mm in a prospective case-controlled study conducted at Al-Ramadi Teaching Hospital, Ar Razi Private Hospital, and Ghazi Al-Hariri Hospital for Surgical Specialties in Anbar and Baghdad, Iraq, from January 2020 to January 2024. This group, referred to as group A, was compared to a control group (group B) comprising 70 adult patients aged 18 to 60. Both groups underwent mini-PCNL procedures.

The study compared various factors, including gender, stone size, and location, operation time, stone-free rate, hemoglobin drop, need for blood transfusion, incidence of postoperative fever, any associated visceral injuries, and the requirement for further interventions such as extracorporeal shock wave lithotripsy or flexible ureteroscopy (ESWL or FURS).

The following were the key findings of the study:

• The ages of patients in group A ranged from 8 months to 15 years, with a mean of 4.30 ± 3.16 years, while group B included adults aged 18 to 60 years, with a mean age of 36.3 ± 12.0 years.
• There were no significant differences in gender distribution, stone size, or location.
• The stone-free rate was 87.01% for group A and 88.57% for group B, showing no statistical difference.
• The average hemoglobin drop was 1.096 ± 0.412 in group A and 1.195 ± 0.110 in group B.
• Blood transfusions were required in one case from each group, with no significant difference.
• There were three cases in group A and two in group B needing ESWL, with no statistical difference between the groups.
• FURS was required in four cases in group A and three in group B.
• The operative time ranged from 30 to 125 minutes for group A and from 34 to 129 minutes for group B.
• Postoperative fever occurred in 23 cases in group A and 21 cases in group B (p-value 0.986).
• Minor liver injuries were reported in one case from each group.

"The findings indicate that mini-PCNL is a safe and effective method for treating renal stones in children, with a low rate of significant complications and a high stone-free rate," the researchers concluded.

Reference:

Jaffal, W.N., Al-Timimi, H.F.H., Hassan, O.A. et al. The safety and efficacy of miniaturized percutaneous nephrolithotomy in children. Urolithiasis 52, 142 (2024). https://doi.org/10.1007/s00240-024-01643-7