Adult-sized instruments feasible for use in paediatric percutaneous nephrolithotomy

Performing percutaneous nephrolithotomy (PCNL) with adult-sized instruments in children yields comparable outcomes as when using paediatric-sized instruments, according to a study.

Researchers conducted a systematic literature review and meta-analysis of studies that evaluated PCNL with adult- (24Fr and above) and paediatric-sized instruments in children aged ≤17 years. They searched multiple online databases and identified 84 abstracts and 16 full-text articles; six retrospective studies were included in the meta-analysis.

Pooled data revealed no significant difference between adult- and paediatric-sized instruments in terms of PCNL outcomes such as number of accesses (odds ratio [OR], 0.96, 95 percent confidence interval [CI], 0.52–1.78; p=0.89), initial stone-free rate (OR, 0.73, 95 percent CI, 0.42–1.27; p=0.26), final stone-free rate (OR, 1.14, 95 percent CI, 0.38–3.44; p=0.82), and residual stones (OR, 0.79, 95 percent CI, 0.42–1.49; p=0.46).

Overall complication rates were also comparable in the two groups. However, the use of adult-sized instrument was associated with a higher incidence of grade III/IV complications in one study and a greater haemoglobin/haematocrit decline in three studies.

Duration of surgery, fluoroscopy time, length of hospital stay, times to nephrostomy tube removal, and transfusion rate could not be evaluated in the meta-analysis, although these outcomes were comparable between the adult- and paediatric-sized groups.

The use of adult-sized instruments was also found to be feasible in children aged <3 years and those with staghorn calculi as well as in fluoroscopy-free ultrasound-guided PCNL.

The number and design of the studies restrict the reliability of the comparisons, the researchers acknowledged. Nevertheless, the findings suggest that adult-sized instruments can be applied in paediatric PCNL when factors such as accessibility justify their use.

More studies with improved methodology are needed to better reveal the impact of instruments on the outcome of PCNL in children.