Surgical Management Of Pediatric Nephrolithiasis: A Comparative Review Of Current Modalities
DOI:
https://doi.org/10.37547/ijmscr/Volume06Issue02-11Keywords:
Pediatric nephrolithiasis, minimally invasive surgery, percutaneous nephrolithotomy (PCNL)Abstract
The management of pediatric nephrolithiasis has undergone a fundamental paradigm shift from traumatic open surgery to minimally invasive endourological techniques. This review provides a comparative analysis of current surgical modalities, including Extracorporeal Shock Wave Lithotripsy (ESWL), Percutaneous Nephrolithotomy (PCNL), and Retrograde Intrarenal Surgery (RIRS). While open surgery is largely obsolete due to high morbidity, ESWL remains a viable non-invasive option for smaller calculi (<15 mm). However, for large (>20 mm) and complex stone burdens, PCNL and its miniaturized variants (mini-, ultra-mini-, and micro-PCNL) are established as the gold standard, offering superior stone-free rates. RIRS has emerged as a safe, effective alternative for intermediate-sized stones, utilizing advanced flexible ureteroscopy. The review concludes that contemporary treatment necessitates an individualized approach, balancing stone characteristics with anatomical and metabolic factors. Ultimately, the integration of miniaturized technologies optimizes stone clearance while prioritizing renal preservation in the pediatric population.
References
Pecoraro L, Zuccato A, Vitella R, et al. Pediatric Nephrolithiasis: A Changing Landscape Through Time and Space. Medicina (Kaunas). 2024 Dec 2;60(12):1993.
Ramya K, Krishnamurthy S, Manikandan R, et al. Metabolic and Genetic Evaluation in Children with Nephrolithiasis. Indian J Pediatr. 2022 Dec;89(12):1226-1232.
Destro F, Selvaggio GGO, Lima M, et al. Minimally Invasive Approaches in Pediatric Urolithiasis. The Experience of Two Italian Centers of Pediatric Surgery. Front Pediatr. 2020 Jul 29;8:377.
Paraboschi I, Gnech M, De Marco EA, et al. Pediatric Urolithiasis: Current Surgical Strategies and Future Perspectives. Front Pediatr. 2022 Jun 9;10:886425.
Peng T, Zhong H, Hu B, et al. Minimally invasive surgery for pediatric renal and ureteric stones: A therapeutic update. Front Pediatr. 2022 Aug 18;10:902573.
Marra G, Taroni F, Berrettini A, et al. Pediatric nephrolithiasis: a systematic approach from diagnosis to treatment. J Nephrol. 2019 Apr;32(2):199-210.
Önal B. Pediatric stone disease: Current management and future concepts. Turk Arch Pediatr. 2021 Mar;56(2):99-107.
Rizvi SA, Sultan S, Ijaz H, et al. Open surgical management of pediatric urolithiasis: A developing country perspective. Indian J Urol. 2010 Oct;26(4):573-576.
Lao M, Kogan BA, White MD, et al. High recurrence rate at 5-year followup in children after upper urinary tract stone surgery. J Urol. 2014 Feb;191(2):440-444.
Demirtas F, Çakar N, Özçakar ZB, et al. Risk factors for recurrence in pediatric urinary stone disease. Pediatr Nephrol. 2024 Jul;39(7):2105-2113.
Sakly A, Khaldi S, Touati A, et al. Outcomes and complications of percutaneous nephrolithotomy as primary versus secondary procedure for kidney stones: a prospective cohort study. Ann Med Surg (Lond). 2024 Aug 30;86(10):5711-5715.
Cao B, Daniel R, McGregor R, Tasian GE. Pediatric Nephrolithiasis. Healthcare (Basel). 2023 Feb 13;11(4):552.
Satjakoesoemah AI, Alfarissi F, Wahyudi I, et al. Factors related to the success rate of pediatric extracorporeal shock wave lithotripsy (ESWL) in Cipto Mangunkusumo Hospital: an 8-year single-center experience. Afr J Urol. 2021 Jul 3;27:92.
Akinci A, Akpinar C, Babayigit M, et al. Predicting ESWL success by determination of Hounsfield unit on non-contrast CT is clinically irrelevant in children. Urolithiasis. 2022 Apr;50(2):223-228.
Mohamed ER, Elmogazy HM, Zanaty AK, et al. Extracorporeal shock wave lithotripsy for treatment of large pediatric renal pelvic stone burden more than 2 cm. J Pediatr Urol. 2023 Oct;19(5):561.e1-561.e11.
Garcia-Roig M, Delenbach N, Kirsch J, et al. Extracorporeal shock wave lithotripsy versus ureteroscopy for management of pediatric nephrolithiasis in upper urinary tract stones: multi-institutional outcomes of efficacy and morbidity. J Urol. 2019 Aug;202(2):371-378.
Jones P, Bennett G, Aboumarzouk OM, et al. Role of minimally invasive percutaneous nephrolithotomy techniques-micro and ultra-mini PCNL (<15F) in the pediatric population: A systematic review. J Endourol. 2021 Sep;35(9):816-824.
Fang H, Wang Z, Wei K, et al. Safety and efficacy of standard vs. tubeless percutaneous nephrolithotomy in pediatric populations: an updated systematic review and meta-analysis. BMC Urol. 2025 May 2;25(1):110.
Kumar N, Yadav P, Kaushik VN, et al. Mini-versus standard percutaneous nephrolithotomy in pediatric population: a randomized controlled trial. J Pediatr Urol. 2023 Dec;19(6):688-695.
Jaffal WN, Hasan Al-Timimi HF, et al. The safety and efficacy of miniaturized percutaneous nephrolithotomy in children. Urolithiasis. 2024 Oct 14;52(1):142.
Al Mousawi S, Guzel R, Zaid M, et al. Minipercutaneous Nephrolithotomy in the Management of Large and Complex Renal Calculi in Children: How Effective Is It? J Endourol. 2023 Apr;37(4):387-393.
Bitkin A, Özlü DN, Ekşi M, et al. A comparative analysis of the efficacy and safety of mini-percutaneous nephrolithotomy performed in the supine and prone positions for the treatment of pediatric kidney stones: a single-center experience. Urolithiasis. 2023 Oct 17;51(1):122.
Sorokin NI, Afanasievskaya EV, Kadysheva AM, et al. [Mini-PCNL, micro-PCNL or RIRS: comparative efficacy and safety in renal stones up to 2 cm]. Urologiia. 2023 Sep;(4):98-104.
Mahmoud MA, Shawki AS, Abdallah HM, et al. Use of retrograde intrarenal surgery (RIRS) compared with mini-percutaneous nephrolithotomy (mini-PCNL) in pediatric kidney stones. World J Urol. 2022 Dec;40(12):3083-3089.
Wang W, Ge Y, Wang Z, et al. Comparing micropercutaneous nephrolithotomy and retrograde intrarenal surgery in treating 1-2 cm solitary renal stones in pediatric patients younger than 3 years. J Pediatr Urol. 2019 Oct;15(5):517.e1-517.e6.
Farouk A, Tawfick A, Shoeb M, et al. Is mini-percutaneous nephrolithotomy a safe alternative to extracorporeal shockwave lithotripsy in pediatric age group in borderline stones? a randomized prospective study. World J Urol. 2018 Jul;36(7):1139-1147.
Tanidir Y, Sekerci CA, Bujons A, et al. The Utility and Safety of Ureteral Access Sheath During Retrograde Intrarenal Surgery in Children. Urology. 2024 May;187:71-77.
Gatti C, Cerchia E, Della Corte M, et al. Retrograde Intrarenal Surgery for Renal Stones: Is It a Safe and Effective Option in Preschool Children? J Pediatr Surg. 2024 Mar;59(3):407-411.
Tatanis V, Spinos T, Lamprinou Z, et al. Successful Treatment of Multiple Large Intrarenal Stones in a 2-Year-Old Boy Using a Single-Use Flexible Ureteroscope and High-Power Laser Settings. Pediatr Rep. 2024 Sep 11;16(3):806-815.
Mille E, El-Khoury E, Haddad M, et al. Comparison of single-use flexible ureteroscopes with a reusable ureteroscope for the management of paediatric urolithiasis. J Pediatr Urol. 2023 Jun;19(3):248.e1-248.e6.
Thangavelu M, Sawant A, Sayed AA, et al. Retrograde Intrarenal Surgery (RIRS) for upper urinary tract stones in children below 12 years of age: A single centre experience. Arch Ital Urol Androl. 2022 Jun 29;94(2):190-194.
Ozkent MS, Piskin MM, Balasar M, et al. Is Retrograde Intrarenal Surgery as Safe for Children as It Is for Adults? Urol Int. 2021;105(11-12):1039-1045.
Chandramohan V, Siddalingaswamy PM, Ramakrishna P, et al. Retrograde intrarenal surgery for renal stones in children <5 years of age. Indian J Urol. 2021 Jan-Mar;37(1):48-53.
Dogan HS, Asci A, Kahraman O, et al. Comparison of Efficiency and Safety of Retrograde Intrarenal Surgery and Micropercutaneous Nephrolithotomy in Pediatric Kidney Stones Smaller than 2 cm: A Prospective Cohort Study. J Endourol. 2021 Aug;35(8):1124-1129.
Berrettini A, Boeri L, Montanari E, et al. Retrograde intrarenal surgery using ureteral access sheaths is a safe and effective treatment for renal stones in children weighing <20 kg. J Pediatr Urol. 2018 Feb;14(1):59.e1-59.e6.
Chen Y, Deng T, Duan X, et al. Percutaneous nephrolithotomy versus retrograde intrarenal surgery for pediatric patients with upper urinary stones: a systematic review and meta-analysis. Urolithiasis. 2019 Apr;47(2):189-199.
Srisubat A, Potisat S, Lojanapiwat B, et al. Extracorporeal shock wave lithotripsy (ESWL) versus percutaneous nephrolithotomy (PCNL) or retrograde intrarenal surgery (RIRS) for kidney stones. Cochrane Database Syst Rev. 2023 Aug 1;8(8):CD007044.
Zhao FZ, Li J, Tang L, et al. Comparison of efficacy and safety of minimally invasive procedures for 10-20 mm pediatric renal Stones-A bayesian network meta-analysis. J Pediatr Urol. 2020 Dec;16(6):771-781.
Yuan Y, Liang YN, Li KF, et al. A meta-analysis: retrograde intrarenal surgery vs. percutaneous nephrolithotomy in children. Front Pediatr. 2023 May 2;11:1086345.
Tong CM, Ellison JS, Tasian GE. Pediatric stone disease: current trends and future directions. Urol Clin North Am. 2023 Aug;50(3):465-475.
Khurramov , F., Khamidov, B., & Nasimova , M. (2025). UROLITHIASIS IN CHILDREN. Евразийский журнал медицинских и естественных наук, 5(1), 121–128. извлечено от https://in-academy.uz/index.php/EJMNS/article/view/43214
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