Pediatric kidney stone disease presents unique challenges, necessitating minimally invasive techniques. Suction-assisted mini-percutaneous nephrolithotomy (SM-PCNL) is a well-established treatment, while flexible ureteroscopy using a flexible and navigable suction ureteral access sheath (FANS-UAS) is an emerging technique. Both integrate suction to improve stone clearance, reduce intrarenal pressure, and enhance visualization. However, comparative evidence in children remains limited.
This study hypothesized that FANS-UAS would demonstrate comparable stone-free rates (SFR) and perioperative outcomes to SM-PCNL in children with renal stones ≤2 cm, while potentially offering advantages in operative efficiency and patient recovery. We aimed to compare the perioperative outcomes and SFR of FANS-UAS versus SM-PCNL across multiple international centers.
A prospective, multicenter study analyzed 96 pediatric patients (50 FANS-UAS, 46 SM-PCNL) from eight centers. Inclusion criteria were age ≤16 years, normal renal anatomy, and stone burden ≤2 cm. Outcomes included SFR (assessed via 30-day non-contrast CT scan), operative time, complications, and hospital stay.
FANS-UAS demonstrated comparable SFR to SM-PCNL (66.0 % vs. 58.7 % for zero fragments) but with shorter operative times (42.5 vs. 82.5 min, p = 0.025) and hospital stays (2 vs. 3 days, p < 0.001). FANS-UAS was preferred for multiple stones (28 % vs. 0 %, p = 0.005). Complication rates were similar (12.0 % vs. 8.7 %, p = 0.845). Notably, all FANS-UAS patients required pre-stenting, and a lower body mass index (BMI) was associated with FANS-UAS selection (14.0 vs. 19.0 kg/m2, p < 0.001).
FANS-UAS offers advantages in operative duration and utility for multiple stones, though it requires pre-stenting and careful sheath handling. SM-PCNL remains a reliable option with a strong safety record. Study limitations include its non-randomized design, small sample size, and short-term follow-up. The findings suggest that while stone burden is not the sole determinant, factors like BMI and the presence of multiple stones may influence the choice of approach.
FANS-UAS and SM-PCNL are both suitable for managing renal stones up to 2 cm in children. FANS-UAS offers benefits in operative efficiency and managing multiple stones. The choice of technique may be influenced by patient characteristics such as BMI, and ultimately, surgeon experience and comfort remain crucial for procedural success and complication rates.
Journal of pediatric urology. 2026 Feb 26 [Epub ahead of print]
Ee Jean Lim, Steffi Kar Kei Yuen, Bhaskar Kumar Somani, Thomas R W Herrmann, Kemal Sarica, Anna Bujons Tur, Yesica Quiroz Madarriaga, Jaisukh Kalathia, Deepak Reddy Ragoori, Gopal Ramdas Tak, Khi Yung Fong, Roy Zen Sing Teng, Azimdjon N Tursunkulov, Yiloren Tanidir, Rohit Joshi, Chandra Mohan Vaddi, Olivier Traxer, Daniele Castellani, Vineet Gauhar
Department of Urology, Singapore General Hospital, Singapore. Electronic address: ., S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China., University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK., Department of Urology, Kantonspital Frauenfeld, Spital Thurgau AG, Frauenfeld, Switzerland., Department of Urology, Biruni University Hospital, Turkey., Autonomous University of Barcelona, Urology Department, Fundació Puigvert, Spain, Barcelona., Department of Urology, Fundació Puigvert, Carrer de Cartagena, 340-350, Barcelona, 08025, Spain., Fortune Urology Clinic, Botad, Gujarat, India., Department of Urology, Asian Institute of Nephrology and Urology, Hyderabad, India., Department of Urology, Singapore General Hospital, Singapore., Urology Division, AkfaMedline Hospital, Tashkent, Uzbekistan., Department of Urology, Medicana Atasehir Hospital, Istanbul, Turkey., Department of Urology, Aarna Superspeciality Hospital, Gujarat, India., Department of Urology, Preeti Urology & Kidney Hospital, Hyderabad, India., Department of Urology, Sorbonne University, AP-HP, Hôpital Tenon, F-75020, Paris, France., Faculty of Medicine and Surgery, Libera Università Mediterranea (LUM) Giuseppe Degennaro, Casamassima, Italy., Department of Urology, Asian Institute of Nephrology and Urology, Hyderabad, India; Department of Urology, Ng Teng Fong General Hospital, Singapore.