Percutaneous nephrolithotomy and flexible ureteroscopy may have similar outcomes in pediatric nephrolithiasis

1. In the treatment of pediatric patients with renal calculi measuring 10-30 mm, percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery using single-use flexible ureteroscopy (FURS) do not significantly differ in stone-free or complication rates.

Evidence Rating Level: 1 (Excellent)

The two main considerations in surgical intervention for kidney stones are complete stone clearance and minimizing kidney damage. Special consideration must be taken in children, who have a smaller pelvicalyceal system, more delicate tissues, and a more curved ureter compared to adults. With advances in endoscopic technology, minimally invasive techniques have become an effective treatment option. PCNL and FURS are two such options. However, there have been no studies thus far comparing their efficacy and safety in the management of large renal calculi in children. This prospective randomized single blinded study included children younger than 18 years old with a single calyceal renal stone of 10-20 mm in maximum diameter, or a single renal stone 20–30 mm in maximum diameter in addition to multiple renal stones with total stone size 10–30 mm. 113 patients were randomized in a 1:1 ratio to receive PCNL (n = 46; median [IQR] age, 7 [5-9] years; 52.2% female) or FURS (n = 44; median [IQR] age, 6.5 [5-8] years; 47.7% female). The mean ± SD stone sizes in the PCNL and FURS groups were 20.8 ± 5.01 mm and 19.8 ± 4.59 mm, respectively. The primary outcome was the rate of complications according to the Clavien-Dindo grading system. There were 6 (13.0%) and 4 (9.0%) Clavien-Dindo Grade 1 complications in the PCNL and FURS groups, respectively (p > 0.05), and 3 (6.5%) and 2 (4.5%) Clavien-Dindo Grade 2 complications in each group (p > 0.05). There were no Clavien-Dindo Grade III-V complications. 42 (91.3%) patients in the PCNL group and 39 (88.6%) patients in the FURS group were stone-free (p = 0.737). The mean operative time was 78.8 min and 94.2 min in the PCNL and FURS groups, respectively (p < 0.05). Fluoroscopy time and radiation dose were significantly higher in the PCNL group compared to the FURS group (P < 0.05). Overall, in treating children with 10-30 mm renal stones, PCNL and FURS have similar stone-free and complication rates. PCNL offers a shorter operative time but is associated with significantly greater radiation and longer hospital stays.

Click here to read this study in African Journal of Urology

Citation: Eldeeb M, Nagla S, El Gamal O, El Gamal S, Omar MA, Elmaadawy M. Prospective randomized comparison of mini percutaneous nephrolithotomy and retrograde intrarenal surgery for pediatric renal stones (10–30 mm). Afr J Urol. 2026 Oct 27;32(1):78. doi: 10.1186/s12301-026-00625-y.

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