Vacuum-assisted Mini-PCNL versus RIRS with flexible and navigable suction ureteral access sheath for 1–3 cm pediatric stones: A comparative study

OBJECTIVE: Compare vacuum-assisted mini-percutaneous nephrolithotomy (VA-mini PCNL) and RIRS with flexible and navigable suction ureteral access sheath (FANS-RIRS) for pediatric upper urinary tract stones. METHODS: This retrospective study included children under 14 years old with 1-3 cm stones treated from March 2021 to June 2024. Patients matched for demographics and stone characteristics. Primary outcomes included: stone-free rate (SFR), complications, lab parameters, operative time, hospitalization cost and duration. RESULTS: There were 37 children in the VA-mini PCNL group (16 Fr sheath) and 23 in the FANS-RIRS group (10/12 Fr sheath). In the FANS-RIRS group, 34.78% underwent preoperative stent placement. No significant differences were found between groups in SFR (97.3% vs. 91.3%, p = 0.552), surgical time (95 vs. 85 min, p = 0.398), or complication rate (2.7% vs. 4.35%, p = 1). Complications included fever in VA-mini PCNL and perirenal hematoma in FANS-RIRS. Stone baskets were used only in FANS-RIRS (21.74%, p = 0.006). The VA-mini PCNL group had an 81.1% tubeless rate. Neither surgery significantly affected creatinine, blood urea nitrogen (BUN), or hemoglobin levels (p > 0.05). Postoperative white blood cell counts increased in both groups (p = 0.003 and p = 0.039, respectively), with no significant difference between groups (p = 0.331). VA-mini PCNL had a longer hospital stay (9 vs. 7 days, p = 0.001) but lower costs ($1921.50 vs. $2339.68), p < 0.001). CONCLUSION: Both techniques are viable options for pediatric upper urinary tract stones of 1-3 cm. VA-mini PCNL is more cost-effective, while FANS-RIRS offers a shorter hospital stay.