Introduction Kidney stone disease in the paediatric setting is rare but the incidence is rising. Mini PCNL (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 paediatric mini PCNL (mPCNL), which was defined as PCNLs using tract size between 15-20F. Methods A systematic review was carried out in accordance with Cochrane guidelines and AMSTAR checklist. Original studies reporting on outcomes of mPCNL with 20 or more patients (aged ≤18 years) were included. Results 8 studies were finally identified, which satisfied our pre-defined criteria. This include two randomised 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). Weighted mean operative time and length of hospital stay was 76.8 min (range: 20-120 min) and 4.6 days (range: 1-33 days) respectively. The commonest location(s) of stones were lower pole (57%) and renal pelvis (24.3%). Weighted mean initial and overall stone free rate (SFR) was 87.9% (range: 76-97.5%) and 97% (range: 91.3-100%) respectively. None of the cases required intra-operative 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%). Conclusion Mini PCNL is safe and effective in the paediatric population. Further randomised studies will help determine its formal role in paediatric endourology and help guideline recommendations accordingly.
Journal of endourology. 2020 Nov 11 [Epub ahead of print]
Patrick Jones, Amr Hawary, Rupert Beck, Bhaskar K Somani
Great Western Hospitals NHS Foundation Trust, 7766, Urology, Swindon, Swindon, United Kingdom of Great Britain and Northern Ireland; ., Great Western Hospitals NHS Foundation Trust, 7766, Urology, Swindon, Swindon, United Kingdom of Great Britain and Northern Ireland; ., Great Western Hospitals NHS Foundation Trust, 7766, Urology, Swindon, Swindon, United Kingdom of Great Britain and Northern Ireland; ., University Hospitals Southampton NHS Trust, Urology, Southampton, Southampton, United Kingdom of Great Britain and Northern Ireland, SO16 6YD.