Comparison of retrograde intrarenal surgery and mini-percutaneous nephrolithotomy in children with moderate-size kidney stones: results of multi-institutional analysis.
OBJECTIVE
To compare the outcomes of miniaturized percutaneous nephrolithotomy (mini-perc) and retrograde intrarenal surgery (RIRS) in children for 10- to 30-mm renal calculi by evaluating operative data, stone-free rates, and associated complications.


METHODS
The records of 201 pediatric patients who underwent mini-perc (n = 106) or RIRS (n = 95) for intrarenal stones of 10- to 30-mm size were reviewed retrospectively. The χ(2) test was applied to compare the success rates, postoperative complications, and blood transfusion rates, and the Mann-Whitney U test was used to compare the means of hospital stay, fluoroscopy, and operative time for mini-perc and RIRS.


RESULTS
The stone-free rate was 84.2% for the RIRS group and 85.8% for the mini-perc group after a single procedure (P = .745). These percentages increased to 92.6% and 94.3% with adjunctive therapies for RIRS and mini-perc, respectively. Minor complications classified as Clavien I or II occurred in 17% and 8.4% in mini-perc and RIRS, respectively. No major complications (Clavien III-V) occurred in either group. Overall complication rates in mini-perc were higher, but the differences were not statistically significant (P = .07). However, 7 patients in the mini-perc group received blood transfusions, whereas none of the children in the RIRS group were transfused (P = .015). The mean hospital stay, fluoroscopy, and operation times were significantly longer in the mini-perc group.


CONCLUSIONS
This study demonstrates that RIRS is an effective alternative to mini-perc in pediatric patients with intermediate-sized renal stones. Operative time, radiation exposure, hospital stay, and morbidities of percutaneous nephrolithotomy (PNL) can be significantly reduced with the RIRS technique.
Kecioren Training and Research Hospital, Department of Urology, Ankara, Turkey. drberkan@yahoo.com
Berkan
B
Resorlu
Ali
A
Unsal
Abdulkadir
A
Tepeler
Gokhan
G
Atis
Zafer
Z
Tokatli
Derya
D
Oztuna
Abdullah
A
Armagan
Cenk
C
Gurbuz
Turhan
T
Caskurlu
Remzi
R
Saglam
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007669:Kidney Calculi / Q000601:surgery*; D008297:Male; D009403:Nephrostomy, Percutaneous / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies