Comparison of Different Sheath-sized Mini-Percutaneous Nephrolithotomy in Preschool-aged Children

Aim: We compared success rate and complications in infants and preschool-aged children who had undergone mini-percutaneous nephrolithotomy (Mini-PCNL) with two different sizes of tracts for complex renal calculi. Materials and Methods: Two thousand sixty pediatric patients younger than 7 years old who had undergone mini-PCNL between January 2002 and June 2018 were evaluated retrospectively. One hundred forty-nine preschool-aged children and infants (66 girls and 83 boys) with complex kidney stone disease were included. A total of 158 mini-PCNL were performed in the study. These were classified into two groups (the 14Fr group, n=104 [69.8%]; the 20Fr group, n=45 [30.2%]). Results: The mean age of the patients was 3.5±2.0 year-old and 5.2±2.2 year-old in the 14Fr and 20Fr groups, respectively (p=0.158). There was an superiority of 14Fr group over 20Fr group in terms of significant reduction of hemoglobin difference (0.73 gr/dL vs. 1.0 gr/dL, p=<0.041), blood transfusion rate (3.6% vs. 16.7, p=0.013), fluoroscopy time (4.29 min. vs 5.42 min., p=<0.001), mean fragmented stone size per minute (4.29 mm2/min vs 5.43 mm2/min, p=0.016), operative time (65.2 vs 74.1 min, p=0.040 ), catheter removal time (2.58 days vs. 2.89 days, p<0.001) and hospitalization (3.78 days vs. 4.67 days, p=0.010), respectively. However, no significant differences were observed regarding gender, laterality, location, burden, and the opacity of the stone, presence of hydronephrosis, number of previous stone treatments, accesses achieved, calyces accessed, stone clearance rate, diversion types, complications, and stone-free rates between the groups. Conclusions: This study expressed that the mini-PCNL performed by 14Fr was superior over that by 20Fr sheath regarding the significant reduction of hemoglobin drop, blood transfusion rate, catheter removal time, and duration of hospitalization. The stone-free rates and the other parameters were comparable in both groups.