Risk stratification for postoperative complications following pediatric percutaneous nephrolithotomy: A 10-year single-centre analysis.

OBJECTIVE

To identify predictors of postoperative complications following pediatric percutaneous nephrolithotomy (PCNL).

METHODS

A retrospective study was conducted on children (<18 years) undergoing PCNL between 2014 and 2024 at a tertiary care centre. Demographic, clinical, and operative variables were analysed. Forward stepwise logistic regression was used to identify independent predictors of complications.

RESULTS

A total of 100 children were included (mean age 8.59 ± 3.63 years). The overall complication rate was 41%, with most being Clavien-Dindo grade I-II (32%). Infection-related complications were most common (20%). Multivariable analysis identified supracostal access (OR 2.82, 95% CI 1.07-7.44; p = 0.036), preoperative urinary diversion (PCN/DJ stent) (OR 4.87, 95% CI 1.90-12.49; p = 0.001), and positive urine culture (OR 4.89, 95% CI 1.13-21.18; p = 0.034) as independent predictors of postoperative complications. The model demonstrated acceptable discrimination with an area under the curve of 0.753.

CONCLUSION

Supracostal access, positive urine culture, and preoperative urinary diversion significantly increase the risk of complications following pediatric PCNL. These variables may be used to identify high-risk patients and guide perioperative optimisation strategies.