Risk stratification for postoperative complications following pediatric percutaneous nephrolithotomy: A 10-year single-centre analysis.

OBJECTIVE: To identify predictors of postoperative complications following pediatric percutaneous nephrolithotomy (PCNL). METHODS: A retrospective study was conducted on children (<18 years) undergoing PCNL between 2014 and 2024 at a tertiary care centre. Demographic, clinical, and operative variables were analysed. Forward stepwise logistic regression was used to identify independent predictors of complications. RESULTS: A total of 100 children were included (mean age 8.59 ± 3.63 years). The overall complication rate was 41%, with most being Clavien-Dindo grade I-II (32%). Infection-related complications were most common (20%). Multivariable analysis identified supracostal access (OR 2.82, 95% CI 1.07-7.44; p = 0.036), preoperative urinary diversion (PCN/DJ stent) (OR 4.87, 95% CI 1.90-12.49; p = 0.001), and positive urine culture (OR 4.89, 95% CI 1.13-21.18; p = 0.034) as independent predictors of postoperative complications. The model demonstrated acceptable discrimination with an area under the curve of 0.753. CONCLUSION: Supracostal access, positive urine culture, and preoperative urinary diversion significantly increase the risk of complications following pediatric PCNL. These variables may be used to identify high-risk patients and guide perioperative optimisation strategies.