Outcomes of mini-percutaneous nephrolithotomy in pediatric patients with spinal deformities: A controlled comparative study.

PURPOSE: This study aimed to evaluate the safety and efficacy of mini percutaneous nephrolithotomy (Mini-PCNL) in pediatric patients with spinal deformities by comparing their surgical outcomes to those of neurologically normal children, and to identify the specific perioperative challenges associated with managing this complex patient population.

MATERIALS AND

METHODS

A total of 289 pediatric patients who underwent Mini-PCNL between January 2016 and January 2025 were retrospectively analyzed. Of these, 17 (5.9%) had spinal deformities and formed the study group, while 272 neurologically normal children comprised the control group. Demographic data, stone burden, perioperative parameters, clinical outcomes, and complications were compared between groups. Statistical analysis was performed using the Mann-Whitney U test for continuous variables and the Chi-Square test for categorical variables. A p-value <0.05 was considered statistically significant.

RESULTS

Patients in the spinal deformity group had a significantly higher median age (10 vs. 4 years, p<0.001), greater stone burden (300 mm² vs. 200 mm², p=0.009), and longer durations of anesthesia (125 minutes vs. 91 minutes, p<0.001) and surgery (95 minutes vs. 75 minutes, p=0.040), as well as an extended hospital stay (5 vs. 3 days, p<0.001). This group also had a significantly shorter follow-up duration (10 vs. 30 months, p<0.001). The initial stone-free rate was significantly lower in the spinal deformity group (70.6% vs. 86.4%, p=0.05), although the final stone-free rates were comparable between the groups (88.2% vs. 96.3%, p=0.20). Residual stone rates (29.4% vs. 13.6%, p=0.05) and the need for blood transfusions (11.8% vs. 2.9%, p=0.05) were significantly higher in the spinal deformity group. While the overall and major complication rates were higher in this group, the differences were not statistically significant.

CONCLUSION

Mini-PCNL is a feasible and effective treatment option for pediatric patients with spinal deformities. Despite increased technical complexity and intraoperative risk, acceptable stone-free outcomes and manageable complication rates can be achieved with experienced surgical teams and structured perioperative care. Further prospective studies are warranted to assess long-term outcomes in this vulnerable population.