Outcomes and complications of different approaches for 1-2 cm upper tract stones in the paediatric population: bicentric retrospective analysis

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.