Supine mini-PCNL using pneumatic lithotripsy for pediatric renal stones: safety and efficacy in low-income countries.

BACKGROUND

Mini-percutaneous nephrolithotomy (mini-PCNL) is an effective surgical technique for pediatric renal stones. However, data comparing different lithotripsy modalities in this population are limited.

PURPOSE: To compare the efficacy, safety, and acute renal parenchymal impact of pneumatic lithotripsy versus Holmium: YAG (Ho: YAG) laser dusting during supine mini-percutaneous nephrolithotomy (mini-PCNL) in pediatric patients.

PATIENTS AND

METHODS

A double-masked, randomized clinical trial was conducted between March 2023 and October 2024. A total of 104 pediatric patients (ages 3-10 years) with solitary renal stones (10-25 mm) were randomized into two groups: Group 1 (n = 53) underwent mini-PCNL using a pneumatic lithotripter, and Group 2 (n = 51) underwent mini-PCNL using Ho: YAG laser dusting. Primary outcomes included operative time, stone-free rate (SFR), complications (Clavien-Dindo), and biochemical markers of renal injury, including Kidney Injury Molecule-1 (KIM-1) and albumin/creatinine (A/C) ratio.

RESULTS

Pneumatic lithotripsy demonstrated significantly shorter mean operative times (59.5 vs. 67.6 min, p = 0.007) and lithotripsy times (p < 0.001) compared to the laser group. The stone-free rates were comparable between the pneumatic and laser groups (92.45% vs. 94.1%, p > 0.05). Group 1 (pneumatic) had a significantly shorter hospital stay (2.2 vs. 2.6 days, p = 0.004). While both groups showed postoperative elevations in injury markers, the laser group exhibited significantly higher and more sustained levels of urinary KIM-1 and A/C ratios, as well as higher postoperative RBC counts in nephrostomy samples (p < 0.05). No major complications or perforations occurred in either group.

CONCLUSIONS

Pneumatic lithotripsy is a highly effective and safe alternative to laser lithotripsy for pediatric mini-PCNL. It offers comparable operative efficiency, reduced hospital stays, and potentially lower acute tubular injury as evidenced by lower KIM-1 levels. Given its lower cost and comparable stone-free rates, pneumatic lithotripsy is a favorable option for managing pediatric renal stones in resource-conscious settings.