Supine mini-PCNL using pneumatic lithotripsy for pediatric renal stones: safety and efficacy in low-income countries
Clinical Snapshot
PICO Framework
| P — Population | Pediatric patients aged 3-10 years with solitary renal stones 10-25mm in diameter |
| I — Intervention | Supine mini-percutaneous nephrolithotomy using pneumatic lithotripsy |
| C — Comparator | Supine mini-percutaneous nephrolithotomy using Holmium:YAG laser dusting |
| O — Outcomes | Primary: operative time, stone-free rate, complications (Clavien-Dindo), biochemical markers of renal injury (KIM-1, albumin/creatinine ratio). Secondary: hospital stay, lithotripsy time, postoperative RBC counts |
Bottom Line
This randomised trial of 104 children demonstrates that pneumatic lithotripsy achieves comparable stone-free rates to laser lithotripsy in mini-PCNL (92.5% vs 94.1%) while offering significant advantages in operative efficiency and cost-effectiveness. The pneumatic approach reduced mean operative time by 8 minutes and hospital stay by 0.4 days, with lower renal injury biomarkers suggesting reduced acute tubular damage. No major complications occurred in either group. For Australian pediatric urologists, these findings support pneumatic lithotripsy as a viable first-line option for appropriately sized renal stones, particularly in resource-conscious public health settings. The comparable efficacy with reduced costs and potentially lower renal injury makes this approach attractive for routine practice, though the single-centre design and lack of long-term follow-up warrant cautious interpretation.
Key Findings
P Value: p=0.007 for operative time difference, p<0.001 for lithotripsy time
Effect Size: Mean operative time difference: 8.1 minutes shorter with pneumatic lithotripsy
Primary Outcome: Stone-free rate: 92.45% (pneumatic) vs 94.1% (laser), p>0.05
Nnt Or Sensitivity: Hospital stay reduction: 0.4 days shorter with pneumatic approach
Confidence Interval: Not reported in abstract
Clinical Application
Highly feasible in Australian centres with existing mini-PCNL capabilities, requires standard pneumatic lithotripsy equipment Relevant to Australian pediatric urology practice, particularly in public hospitals where cost-effectiveness is prioritised. May influence PBS considerations for laser equipment funding in pediatric centres Pediatric patients aged 3-10 years with renal stones 10-25mm requiring surgical intervention
Abstract
BACKGROUND: Mini-percutaneous nephrolithotomy (mini-PCNL) is an effective surgical technique for pediatric renal stones. However, data comparing different lithotripsy modalities in this population are limited. PURPOSE: To compare the efficacy, safety, and acute renal parenchymal impact of pneumatic lithotripsy versus Holmium: YAG (Ho: YAG) laser dusting during supine mini-percutaneous nephrolithotomy (mini-PCNL) in pediatric patients. PATIENTS AND METHODS: A double-masked, randomized clinical trial was conducted between March 2023 and October 2024. A total of 104 pediatric patients (ages 3-10 years) with solitary renal stones (10-25 mm) were randomized into two groups: Group 1 (n = 53) underwent mini-PCNL using a pneumatic lithotripter, and Group 2 (n = 51) underwent mini-PCNL using Ho: YAG laser dusting. Primary outcomes included operative time, stone-free rate (SFR), complications (Clavien-Dindo), and biochemical markers of renal injury, including Kidney Injury Molecule-1 (KIM-1) and albumin/creatinine (A/C) ratio. RESULTS: Pneumatic lithotripsy demonstrated significantly shorter mean operative times (59.5 vs. 67.6 min, p = 0.007) and lithotripsy times (p < 0.001) compared to the laser group. The stone-free rates were comparable between the pneumatic and laser groups (92.45% vs. 94.1%, p > 0.05). Group 1 (pneumatic) had a significantly shorter hospital stay (2.2 vs. 2.6 days, p = 0.004). While both groups showed postoperative elevations in injury markers, the laser group exhibited significantly higher and more sustained levels of urinary KIM-1 and A/C ratios, as well as higher postoperative RBC counts in nephrostomy samples (p < 0.05). No major complications or perforations occurred in either group. CONCLUSIONS: Pneumatic lithotripsy is a highly effective and safe alternative to laser lithotripsy for pediatric mini-PCNL. It offers comparable operative efficiency, reduced hospital stays, and potentially lower acute tubular injury as evidenced by lower KIM-1 levels. Given its lower cost and comparable stone-free rates, pneumatic lithotripsy is a favorable option for managing pediatric renal stones in resource-conscious settings.
References
- 1.Ali, M. M., Fathelbab, T. K., Tantawy, H. H., Kamel, A. K., Reda, A. M., & Kasem, M. H. (2026). Supine mini-PCNL using pneumatic lithotripsy for pediatric renal stones: safety and efficacy in low-income countries. World Journal of Urology. https://doi.org/10.1007/s00345-022-04069-1
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