Bruniera M. et al., 2026: Outcomes and complications of different approaches for 1-2 cm upper tract stones in the paediatric population: bicentric retrospective analysis.

Bruniera M, Basso G, Botti S, Grossele M, Gnech M, Berrettini A, Beltrami P, Montini G, Taroni F, Mancuso MC, Vidal E, Sangermano M, Longo G, Dal Moro F, Morlacco A
Pediatr Surg Int. 2026 Apr 15;42(1):196. doi: 10.1007/s00383-026-06372-z FREE ARTICLE

Abstract

PURPOSE: To evaluate outcomes and complications of different surgical approaches for 10–20 mm internal stones in children, based on bicentric real-world experience. MATERIALS AND METHODS: We retrospectively analysed 96 patients treated between 2009 and 2022 at two tertiary referral centres. Data included demographics, stone characteristics, treatment (extracorporeal shockwave lithotripsy -SWL, retrograde surgery -RIRS, percutaneous nephrolithotomy – PCNL, surgery), complications, and stone-free rates. The primary outcome was stone clearance; complications were graded according to the Clavien-Dindo classification. Categorical variables were compared using Chi-square of Fisher’s exact test. RESULTS: Median age was 61 months (IQR 25–105). Nineteen patients (19.8%) had associated urological conditions. 50% had multiple stones. Treatments included SWL (17.7%), URS/RIRS (46.9%), PCNL (19.8%), and surgery (8.3%). Intraoperative complications occurred in 4.2%, early postoperative in 12.5%, and late complications in 11.5%. Stone clearance after the first procedure was achieved in 47.9%. Clearance rates were 58.8% for SWL, 47.8% for URS/RIRS, and 52.6% for PCNL. No statistically significant differences were observed in stone clearance or complication rates among treatments. CONCLUSIONS: All treatments demonstrated safety and efficacy for 10–20 mm pediatric intrarenal stones. Individualized treatment planning, considering stone burden and patient-specific factors, remains essential to optimize outcomes.

Comment Peter Alken

This is what I call a We-Too paper We too did stone treatment in children.

However: “This study has several limitations. Its retrospective design and clinically driven treatment allocation introduce an inherent risk of selection bias. The long inclusion period (2009–2022) spans substantial technological evolution in endourology, including advances in miniaturized instruments, flexible ureterorenoscopes, which may have influenced outcomes, and the decision make process supporting the choice of URS/RIRS. In addition, the small sample size within each group, limits statistical power and procedures definitive comparative conclusions”

Peter Alken