Role of Mini-Percutaneous Nephrolithotomy in the Management of Pediatric Stone Disease: A Systematic Review of Literature

Abstract

Introduction: Kidney stone disease in the pediatric setting is rare, but the incidence is rising. Mini-percutaneous nephrolithotomy (mPCNL) is one of the newer surgical interventions to have been developed in recent decades. The aim of this study was to carry out a systematic review (SR) to formally evaluate the safety and efficacy of pediatric mPCNL, which was defined as PCNLs using tract size between 15F and 20F. Methods: An SR was carried out in accordance with Cochrane guidelines and A MeaSurement Tool to Assess systematic Reviews (AMSTAR) checklist. Original studies reporting on outcomes of mPCNL with 20 or more patients (aged ≤18 years) were included. Results: Eight studies were finally identified, which satisfied our predefined criteria. This included two randomized trials and six cohort studies. A total of 384 patients with a weighted mean age of 7.5 years (range: 0.5-18 years) and a male:female ratio of 3:2 underwent mPCNL. The weighted mean stone size was 1.2 cm (range: 0.8-3.5 cm). The weighted mean operative time and length of hospital stay were 76.8 minutes (range: 20-120 minutes) and 4.6 days (range: 1-33 days), respectively. The most common location(s) of stones were lower pole (57%) and renal pelvis (24.3%). The weighted mean initial and overall stone-free rates were 87.9% (range: 76%-97.5%) and 97% (range: 91.3%-100%), respectively. None of the cases required intraoperative conversion to standard PCNL. Complications occurred in 19% (n = 73) of patients. The weighted mean transfusion rate reported across studies was 3.3% (range: 0%-10.3%). Conclusions: mPCNL is safe and effective in the pediatric population. Further randomized studies will help determine its formal role in pediatric endourology and help guideline recommendations accordingly.

Keywords: mini-PCNL; minimally invasive surgery; pediatric; percutaneous nephrolithotomy; urolithiasis.