Standard versus miniaturized percutaneous nephrolithotomy in pediatric patients: a systematic review and meta-analysis.

BACKGROUND: Although miniaturized percutaneous nephrolithotomy (mini-PCNL) is a less invasive alternative to standard percutaneous nephrolithotomy (PCNL), its comparative outcomes in pediatric patients remain unclear. OBJECTIVES: To compare the efficacy and safety of mini-PCNL versus standard PCNL in children with nephrolithiasis. DESIGN AND SETTING: Systematic review and meta-analysis conducted according to PRISMA guidelines, including randomized controlled trials (RCTs) and retrospective cohort studies of pediatric patients undergoing mini-PCNL or standard PCNL. METHODS: Major databases (Cochrane Library, PubMed/MEDLINE, and Embase) were searched through August 2024. The primary endpoint was the stone-free rate. Secondary endpoints included operative time, postoperative fever, and complications classified by the Clavien-Dindo system. RESULTS: Five studies (two RCTs and three retrospective cohort studies) involving 490 patients (46% underwent mini-PCNL) were included. Stone-free rates were comparable between the groups (relative risk [RR], 0.98; 95% confidence interval [CI], 0.929-1.041; p = 0.56; I2 = 0%). Mini-PCNL was associated with longer operative times (mean difference [MD], 7.5 min; 95% CI, 0.2-14.9; p = 0.04; I2 = 78%) but a lower risk of Clavien-Dindo grade I complications (RR 0.464; 95% CI 0.442-0.944; p < 0.05; I2 = 0%). No significant differences were observed in postoperative fever or Clavien-Dindo grade II-IV complications. CONCLUSION: Mini-PCNL and standard PCNL achieve comparable stone-free rates in pediatric patients. Mini-PCNL is associated with fewer minor complications, whereas standard PCNL is associated with shorter operative times. Both techniques demonstrate similar safety profiles with respect to major complications. CLINICAL TRIAL OR SYSTEMATIC REVIEW REGISTRATION: PROSPERO: CRD42024618399; available at: https://www.crd.york.ac.uk/PROSPERO/view/CRD42024567890.