Shahid Labbafinejad Hospital, Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Uro-Oncology Research Center, Tehran University of Medical Sciences, Tehran, Iran.
J Pediatr Urol. 2022 Jun;18(3):303-310. doi: 10.1016/j.jpurol.2022.04.014. Epub 2022 Apr 22.
Little evidence exists regarding the benefits and disadvantages of adult-sized instruments for Percutaneous Nephrolithotomy (PCNL) in pediatric patients. This systematic review aims to clarify the safety and efficacy of this approach.
We conducted a systematic literature review using databases of PubMed, Scopus, Embase, Web of Science, and Cochrane and included studies that evaluated PCNL in children. All identified records underwent two-phase title/abstract and full-text screening. Pediatric patients were defined as 17 years or younger, and adult-sized instruments as 24Fr and above. The primary outcomes were success (stone-free) rate and surgical complications obtained from studies comparing adult-sized and pediatric-sized instruments.
A total of 84 abstracts and 16 full text article were assessed till July 2021 and 6 studies were included. All studies were retrospective. Number of accesses (Odds ratio (OR), adult-sized to pediatric-sized: 0.96, 95% CI: 0.52-1.78, p = 0.89), initial stone-free rate (OR: 0.73, 95% CI: 0.42-1.27, p = 0.26), final stone-free rate (OR: 1.14, 95% CI: 0.38-3.44, p = 0.82), and residual stones (OR: 0.79, 95% CI: 0.42-1.49, p = 0.46) could be analyzed, none with significant differences. Overall complication rates did not differ significantly between the groups. However, one study reported more grade III/IV complications in the adult-sized instrument group. The adult-sized instrument group had a higher hemoglobin/hematocrit decrease in 3 studies. Duration of surgery, fluoroscopy time, length of hospital stay, times to nephrostomy tube removal, and transfusion rate could not be assessed in meta-analysis; however, they were comparable between the adult-sized and pediatric-sized groups. Studies also showed that adult-sized instruments are applicable in children younger than 3 years and those with staghorn calculi as well as in fluoroscopy-free ultrasound-guided PCNL.
Adult-sized instruments had comparable outcomes to the pediatric-sized ones and can be applied in pediatric PCNL when factors such as accessibility justify their use. The number and design of the studies restrict the reliability of the comparisons. Therefore, future studies with improved methodology may better reveal the impact of instruments on the outcome of PCNL in children.
关于成人尺寸器械在小儿经皮肾镜取石术（PCNL）中的益处和弊端，目前相关证据有限。本系统综述旨在阐明该方法的安全性和有效性。
我们使用 PubMed、Scopus、Embase、Web of Science 和 Cochrane 数据库进行了系统文献检索，并纳入了评估儿童 PCNL 的研究。所有鉴定的记录都经过了标题/摘要和全文筛选的两阶段评估。小儿患者定义为 17 岁或以下，而成人尺寸器械为 24Fr 及以上。主要结局是从比较成人尺寸和小儿尺寸器械的研究中获得的成功率（结石清除率）和手术并发症。
截至 2021 年 7 月，共评估了 84 篇摘要和 16 篇全文文章，最终纳入 6 项研究。所有研究均为回顾性研究。通道数量（优势比（OR），成人尺寸与小儿尺寸：0.96，95%CI：0.52-1.78，p=0.89）、初始结石清除率（OR：0.73，95%CI：0.42-1.27，p=0.26）、最终结石清除率（OR：1.14，95%CI：0.38-3.44，p=0.82）和残余结石（OR：0.79，95%CI：0.42-1.49，p=0.46）可以进行分析，但均无显著差异。两组总体并发症发生率无显著差异。然而，有一项研究报告称，成人尺寸器械组的 III/IV 级并发症更多。3 项研究表明，成人尺寸器械组血红蛋白/血细胞比容下降幅度更大。无法进行手术时间、透视时间、住院时间、肾造瘘管拔除时间和输血率的荟萃分析，但这些指标在成人尺寸和小儿尺寸组之间是可比的。研究还表明，成人尺寸器械适用于年龄小于 3 岁、鹿角状结石以及无透视超声引导下 PCNL 的儿童。
成人尺寸器械的结果与小儿尺寸器械相当，当可及性等因素证明其使用合理时，可应用于小儿 PCNL。研究数量和设计限制了比较的可靠性。因此，未来采用改进方法的研究可能会更好地揭示器械对儿童 PCNL 结果的影响。
