Minimally invasive versus standard percutaneous nephrolithotomy for the treatment of pediatric renal calculi: a meta-analysis

Percutaneous nephrolithotomy (PCNL) is recognized as an established treatment for large renal calculi in pediatric patients, and the selection of the access tract is of particular importance. The objective of this study was to compare the efficacy and safety of minimally invasive PCNL (mPCNL) versus standard PCNL (sPCNL) in the treatment of pediatric renal calculi. A systematic literature search was conducted across PubMed, Scopus, Web of Science, Cochrane Library, and Google Scholar from database inception to June 30, 2025. All comparative studies evaluating mPCNL versus sPCNL for the treatment of pediatric renal calculi were included. Statistical analyses were performed using Review Manager 5.3 software. Funnel plot was used to evaluated publication bias. A total of 12 articles were included, involving 1,308 pediatric patients with 1,332 renal units. The results indicated that mPCNL had a comparable stone-free rate compared with sPCNL [odds ratio (OR) = 1.08, 95% confidence interval (CI): 0.80–1.44, P = 0.62]. Furthermore, mPCNL demonstrated a significantly lower hemoglobin drop [mean difference (MD) = -0.64, 95% CI: -0.99 to -0.29, P = 0.0003], fewer blood transfusions (OR = 0.49, 95% CI: 0.24–0.98, P = 0.04), and shorter hospital stay (MD = -0.40, 95% CI: -0.58 to -0.23, P < 0.00001). However, mPCNL required a longer operation time (MD = 7.04, 95% CI: 0.39–13.69, P = 0.04). In addition, mPCNL demonstrated a significantly lower overall complication rate (OR = 0.59, 95% CI: 0.42–0.81, P = 0.001) and markedly reduced the incidence of Clavien grade > II complications (OR = 0.38, 95% CI: 0.17–0.89, P = 0.03). The funnel plot indicated that there was no obvious publication bias. mPCNL achieves a comparable stone clearance rate to sPCNL and demonstrates a higher safety; however, it requires more operation time. The protocol of this study has been registered in the PROSPERO (No. CRD420251123080).