Tubeless PNL can safely be applied to selected patients in pediatric stone disease.

Abstract

The purpose of this study was to compare the results of tubeless percutaneous nephrolithotomy (TPNL) and standard percutaneous nephrolithotomy (SPNL) for the management of nephrolithiasis in children. The data for 48 patients aged lesser than 18 years who underwent percutaneous nephrolithotomy (PNL) between January 2010 and June 2018 were reviewed retrospectively. The patients were classified into 2 categories depending on tube placement. A total of 21 patients were treated with TPNL and 27 with SPNL technique. The surgical method employed was selected depending on intraoperative complications. The size of the endoscopic instrument (mini/standard) to be used was decided according to the stone burden and surgeon preference. A complete stone-free rate (SFR) was achieved in 85.7% (n=18) of the TPNL group and 85.2% (n=23) of the SPNL group (p=0.959). In the TPNL group, two patients with clinically significant stones underwent retrograde intrarenal surgery, and one patient with clinically insignificant residual stone remained under follow-up. In the SPNL group, two patients with clinically significant stones underwent repeat mini-PNL surgery, the stones being fragmented with shock wave lithotripsy in one patient, and 1 one patient with insignificant residual stone remained under follow-up. No significant differences were observed in terms of intraoperative and postoperative complications, mean SFRs, or operative and fluoroscopy times. However, a statistically significant difference was observed in lengths of hospital stay (p<0.001). TPNL is a safe and effective procedure in children. No significant difference was found between TPNL and SPNL in terms of stone clearance; however, patients undergoing TPNL had significantly shorter hospital stays.