Compare vacuum-assisted mini-percutaneous nephrolithotomy (VA-mini PCNL) and RIRS with flexible and navigable suction ureteral access sheath (FANS-RIRS) for pediatric upper urinary tract stones.
This retrospective study included children under 14 years old with 1-3 cm stones treated from March 2021 to June 2024. Patients matched for demographics and stone characteristics. Primary outcomes included: stone-free rate (SFR), complications, lab parameters, operative time, hospitalization cost and duration.
There were 37 children in the VA-mini PCNL group (16 Fr sheath) and 23 in the FANS-RIRS group (10/12 Fr sheath). In the FANS-RIRS group, 34.78% underwent preoperative stent placement. No significant differences were found between groups in SFR (97.3% vs. 91.3%, p=0.552), surgical time (95 vs. 85 minutes, p=0.398), or complication rate (2.7% vs. 4.35%, p=1). Complications included fever in VA-mini PCNL and perirenal hematoma in FANS-RIRS. Stone baskets were used only in FANS-RIRS (21.74%, p=0.006). The VA-mini PCNL group had an 81.1% tubeless rate. Neither surgery significantly affected creatinine, blood urea nitrogen (BUN), or hemoglobin levels (p>0.05). Postoperative white blood cell counts increased in both groups (p=0.003 and p=0.039, respectively), with no significant difference between groups (p=0.331). VA-mini PCNL had a longer hospital stay (9 vs. 7 days, p=0.001) but lower costs ($1921.50 vs. $2339.68) , p<0.001).
Both techniques are viable options for pediatric upper urinary tract stones of 1-3 cm.VA-mini PCNL is more cost-effective, while FANS-RIRS offers a shorter hospital stay.
Journal of pediatric surgery. 2026 Jul 18 [Epub ahead of print]
Ming Sheng, Mei Huang, Zichi Wu, Ping Li, Liuqiang Li, Yanbing Liang, Weifeng Zou, Jun Bian, Weizhong Yang, Meiling Chen, Dehui Lai
Department of urology, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China; Department of urology, Shufu County People's Hospital, Kashi, Xinjiang, China., Department of urology, The Affiliated Huizhou Hospital, Guangzhou Medical University, Huizhou, Guangdong, China., Department of urology, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China., Department of urology, The Sixth Affiliated Hospital of Jinan University, Dongguan, Guangdong, China., Department of urology, Shufu County People's Hospital, Kashi, Xinjiang, China., Department of urology, The Affiliated Huizhou Hospital, Guangzhou Medical University, Huizhou, Guangdong, China. Electronic address: ., Department of urology, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China. Electronic address: ., Department of urology, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China. Electronic address: .