Endoscopic Nephrolithotripsy In Children For Renal Calculus (1- 2 Cm): An Observational Study In A Tertiary Care Centre

Background: Paediatric nephrolithiasis, although accounting for a small percentage of total stone formers, has been on the rise, particularly among adolescents. Effective and minimally invasive surgical interventions are crucial for achieving high stone-free rates (SFR) while minimizing complications and hospital stay durations in this vulnerable population. Objectives: This study aimed to evaluate and compare the safety and efficacy of Retrograde Intrarenal Surgery (RIRS) and Mini Percutaneous Nephrolithotomy (mPCNL) in treating renal calculus in children under twelve. The primary outcome was the rate of stone clearance, while secondary outcomes included operative time, complication rates, changes in haemoglobin levels, length of hospital stay, and retreatment rates. Methods: A retrospective observational study was conducted at the Department of Urology and Renal Transplant, Gauhati Medical College and Hospital, over two years. Thirty-five paediatric patients (age less than 12 years) with renal calculi 1-2 cm were enrolled, with 14 undergoing RIRS and 21 undergoing mPCNL. Preoperative evaluations included renal function tests, metabolic assessments, and imaging studies (ultrasonography and plain CT KUB). Surgical procedures were standardized, and outcomes were assessed using the modified Clavien classification for complications. Data analyzed using statistical software, employing Chi-square tests for categorical variables and t-tests for continuous variables, with a significance threshold set at p<0.05. Results: RIRS patients had significantly longer operative times (100 ± 20 minutes vs 90 ± 15 minutes, p<0.001), minimal blood loss (Hb change –0.2 ± 0.3 vs. –1.3 ± 0.5 g/dL, p<0.001), and reduced hospital stays (1.2 ± 0.5 vs. 3.5 ± 1.2 days, p<0.001). However, Mini PCNL achieved a higher stone-free rate (93% vs. 75%, p=0.03) and lower retreatment rates (7% vs. 25%, p=0.02). Demographic and metabolic profiles were comparable between groups, while complication rates were significantly higher with Mini PCNL [Table 1]. Conclusion: Mini Percutaneous Nephrolithotomy (mPCNL) demonstrated superior efficacy in achieving higher stone-free rates and lower retreatment requirements compared to Retrograde Intrarenal Surgery (RIRS) in paediatric patients with renal calculi. However, mPCNL was associated with higher minor complication rates, greater haemoglobin loss, and extended hospital stays. RIRS offers a safer and less invasive alternative with shorter recovery times, making it suitable for smaller or less complex stones. The choice of surgical modality should be individualized based on stone size, complexity, and patient-specific factors to optimize outcomes and minimize risks Keywords : Paediatric nephrolithiasis, Retrograde Intrarenal Surgery, Mini Percutaneous Nephrolithotomy, Stone-free rate, Complications.