Comparative outcomes of flexible ureteroscopy and mini‐percutaneous nephrolithotomy for pediatric kidney stones larger than 2 cm

Abstract

To compare the outcomes of flexible ureteroscopy and mini-percutaneous nephrolithotomy for pediatric kidney stones larger than 2 cm and to show the learning curves for the two procedures. Methods: A prospectively managed database containing pediatric patients with kidney stones larger than 2 cm from June 2014 to October 2019 was analyzed. The primary outcomes were the efficacy and safety of flexible ureteroscopy and mini-percutaneous nephrolithotomy. Data on patient demographics, treatment details, stone-free rate, and complication rate were collected and compared. Learning curves were generated to estimate the effect of the surgeon's experience on surgical outcomes. Results: The final analysis included 113 pediatric patients who underwent surgery for kidney stones on a total of 126 sides. The stone-free rates for mini-percutaneous nephrolithotomy and flexible ureteroscopy were 80.9% (34/42) and 79.7% (67/84), respectively (P = 0.19). The complication rates for mini-percutaneous nephrolithotomy and flexible ureteroscopy were 52.5% (21/40) and 27.4% (27/73), respectively (P = 0.01). When stone mass was considered, the stone-free rates for mini-percutaneous nephrolithotomy and flexible ureteroscopy for stones with a high mass (>5000 HU*cm 2 ) were 83.3% (20/24) and 55.5% (10/18), respectively (P = 0.04). The learning curves showed that the stone-free rates for both mini-percutaneous nephrolithotomy and flexible ureteroscopy increased with the accumulation of cases. A higher stone-free rate could be achieved after approximately 20 mini-percutaneous nephrolithotomy cases and after approximately 50 flexible ureteroscopy cases. Conclusions: Flexible ureteroscopy has an acceptable stone-free rate and a lower complication rate than mini-percutaneous nephrolithotomy when treating pediatric kidney stones larger than 2 cm. Mini-percutaneous nephrolithotomy is more applicable to stones with a high mass. The stone-free rates achieved after both mini-percutaneous nephrolithotomy and flexible ureteroscopy could be improved with number of cases accumulated.

Use of retrograde intrarenal surgery (RIRS) compared with mini-percutaneous nephrolithotomy (mini-PCNL) in pediatric kidney stones

“…They concluded that the RIRS success rate decreases markedly with stone size above 20 mm [ 24 ]. Also, Zhang et al reported that the SFR achieved by RIRS for stones larger than 2 cm was 79.7% and 80.9% after mini-PCNL [ 25 ]. However, Pelit et al found out that for pediatric stones the SFR of RIRS (75%) was less than the SFR of mini-PCNL (84.4%) [ 19 ].…”

Utilization of Flexible Ureteroscopy in Renal Stones Management in Pediatrics: Single Tertiary Center Experience

“…It has a high success rate with a less invasive procedure. 2,3 Suliman et al 11 employed FURS in pediatric stones with an SFR in the first session reaching 75% and a total SFR reaching 89%. While Chandramohan et al 5 employed FURS in preschool pediatric stones with an SFR reaching 76.3% for stones less than 20 mm.…”

“…The bleeding risk associated with PCNL has encouraged surgeons to use flexible ureteroscopy in children. 2,3 This research aims to evaluate the efficacy and safety of FURS in treating children in our center during the last 5 years.…”

Effect of ultra-mini percutaneous nephrolithotomy and ShuoTong ureteroscopy on the stress response, inflammatory indices, and urokinase level in patients with polycystic kidney disease complicated with renal calculus

“…ShuoTong lens can establish the working channel of the soft and hard lens, integrate gravel and stone removal, increase stone clearance rate, avoid stone escape, and achieve ideal clinical efficacy. Currently, the application of ShuoTong in the treatment of polycystic kidney disease complicated with kidney stones is rarely seen, and further research is still needed (14,15). The purpose of this study was to use UMP combined with ShuoTong ureteroscopy in the treatment of polycystic kidney stones and to explore the effects of different treatment methods on the stress response, inflammatory factors and urokinase in patients with polycystic kidney stones.…”