Comparison of super-mini-percutaneous nephrolithotomy and flexible ureteroscopy for the management of upper urinary tract calculus in children

Abstract

Objective To evaluate the efficacy and safety of super-mini-percutaneous nephrolithotomy (SMP), retrograde intrarenal surgery(RIRS) for children with upper urinary tract calculus. Methods Clinical data of 85 children with upper urinary tract calculi treated by SMP or RIRS from April 2016 to June 2018 were retrospectively analyzed. Patients were divided into two groups according to operative method: group SMP and group RIRS. In group SMP: there were 38 male and 14 female patients; the mean age was(4.6±2.7)years; the mean stone size was (15.2±4.8)mm; 17cases in left side, and 35 cases in right side; multiple stones were found in 18 cases and single stone was found in 34 cases. In group RIRS: there were 18 male and 15 female patients; the mean age was(4.6±3.1)years; the mean stone size was (14.2±5.1)mm; 9 cases in left side, and 24 cases in right side; multiple stones were found in 11 cases and single stone was found in 22 cases. No statistical significance was found between the two groups in sex, age, stone size, stone side(left/right), percentage of multiple calculi(P>0.05). Patients were evaluated with KUB radiography or CT after 1 month. The overall stone-free rate and complications of the two groups were compared. Results Group RIRS compared to group SMP showed longer operative time [(74.2±31.8)min vs. (57.9±27. 8)min, P = 0.015], and hospital stay after operation [(4.8±2. 8)days vs.(3.1±1.3) days, P =0.003]. The overall stone-free rate was 90.4%(47/52) for group SMP, and 48.5%(16/33) for group RIRS(P<0.01). The re-treatment rate was significantly higher in group RIRS compared to group SMP[36.4%(12/33) vs. 1.9%(1/52), P<0.01]. The complication rate was 9.6(3/52) and 27.3%(9/33) for groups SMP and RIRS, respectively (P <0.05). Conclusions SMP was more effective than RIRS to obtain a better stone free rate, less complications and re-treatment rate in children with upper urinary tract renal calculus. Key words: Supper-mini percutaneous nephrolithotomy; Flexible ureteroscopy; Upper urinary tract calculus; Child