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

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.