Journal of pediatric surgery · 2026
Predictors of residual fragments and hemorrhagic complications after pediatric mini-percutaneous nephrolithotomy: A retrospective cohort analysis of 371 renal units.
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Kizilay Emrah, Tosun Halil, Akinsal Emre Can, Sonmez Gokhan, Baydilli Numan, Demirci Deniz
Аннотация
PURPOSE: Pediatric renal stone surgery aims to achieve complete stone clearance with minimal perioperative morbidity. Mini-percutaneous nephrolithotomy (mini-PCNL) is widely used for larger stones, yet factors influencing postoperative residual fragments and bleeding risk in children are not fully clarified. This study evaluated outcomes after pediatric mini-PCNL and identified predictors of residual fragments and bleeding-related morbidity in a large single-center cohort.
MATERIALS AND METHODS: This single-center retrospective cohort included 371 renal units in children treated with mini-PCNL (2011-2024) using 14-20 French (Fr) access sheaths. Stone-free rate (SFR) was defined as 0-mm residual fragments on 1-month kidney-ureter-bladder (KUB) radiography and ultrasonography (US). Computed tomography (CT) was not routinely performed and was obtained only when clinically indicated, which may have resulted in underestimation of very small residual fragments. Multivariable logistic regression evaluated predictors of 1-month residual fragments and bleeding-related morbidity.
RESULTS: One-month SFR was 79.2% (294/371) and increased to 88.4% (328/371) by 3 months after auxiliary procedures. Staghorn morphology was associated with residual fragments (aOR 5.01, 95% CI 1.86-13.51); operative time was also associated (aOR 1.12 per 10-min increase, 95% CI 1.04-1.20). Complications occurred in 12.9%, mainly low-grade according to the Clavien-Madadi classification, with no grade IV-V events. Transfusion was required in 2.2% (8/371). Bleeding-related morbidity increased with operative time (aOR 1.16 per 10-min increase, 95% CI 1.07-1.25). Compared with 14 Fr, 20 Fr demonstrated a nonsignificant trend toward higher odds of bleeding-related morbidity (aOR 3.20, 95% CI 0.93-11.05), whereas 16 Fr showed no statistically significant association (aOR 1.75, 95% CI 0.56-5.47).
CONCLUSION: With a stringent 0-mm stone-free definition, mini-PCNL provided high clearance rates and low major morbidity in this large pediatric cohort. Staghorn stones remained the strongest predictor of residual fragments. Prolonged operative time was consistently associated with increased bleeding-related morbidity, while the use of 20 Fr access demonstrated only a modest, nonsignificant elevation in bleeding risk.
MATERIALS AND METHODS: This single-center retrospective cohort included 371 renal units in children treated with mini-PCNL (2011-2024) using 14-20 French (Fr) access sheaths. Stone-free rate (SFR) was defined as 0-mm residual fragments on 1-month kidney-ureter-bladder (KUB) radiography and ultrasonography (US). Computed tomography (CT) was not routinely performed and was obtained only when clinically indicated, which may have resulted in underestimation of very small residual fragments. Multivariable logistic regression evaluated predictors of 1-month residual fragments and bleeding-related morbidity.
RESULTS: One-month SFR was 79.2% (294/371) and increased to 88.4% (328/371) by 3 months after auxiliary procedures. Staghorn morphology was associated with residual fragments (aOR 5.01, 95% CI 1.86-13.51); operative time was also associated (aOR 1.12 per 10-min increase, 95% CI 1.04-1.20). Complications occurred in 12.9%, mainly low-grade according to the Clavien-Madadi classification, with no grade IV-V events. Transfusion was required in 2.2% (8/371). Bleeding-related morbidity increased with operative time (aOR 1.16 per 10-min increase, 95% CI 1.07-1.25). Compared with 14 Fr, 20 Fr demonstrated a nonsignificant trend toward higher odds of bleeding-related morbidity (aOR 3.20, 95% CI 0.93-11.05), whereas 16 Fr showed no statistically significant association (aOR 1.75, 95% CI 0.56-5.47).
CONCLUSION: With a stringent 0-mm stone-free definition, mini-PCNL provided high clearance rates and low major morbidity in this large pediatric cohort. Staghorn stones remained the strongest predictor of residual fragments. Prolonged operative time was consistently associated with increased bleeding-related morbidity, while the use of 20 Fr access demonstrated only a modest, nonsignificant elevation in bleeding risk.