Introduction Percutaneous nephrolithotomy (PNL) is the treatment of choice in children with complex and large stones. With the experience gained from adult practice, supine PNL is increasingly performed in children as well. We aimed to evaluate the comparative results of prone and supine mini-PNL (m-PNL) performed for large/complex stones in children. Patients and methods The study included children who underwent supine and prone m-PNL at two centers between September 2019-2022. Patients were divided into two groups with a 1:1 ratio to index supine m-PNL and prone m-PNL cases for the size, number, location of the stones, degree of hydronephrosis and age. Operative related parameters, success and complication rates are being discussed on a procedure based manner. Results Fourty-two patients (21 supine, 21 prone) were included. The mean age was 9,6±4 years, mean stone size was 28,8±13,6 mm. Regarding the operative data, while the mean duration of procedure time was 65,7±17,8 min in supine group, 86,9±19,0 min in prone group (p=0,001). Fluoroscopy time was shorter in supine group (p=0,027). While tubeless PNL was performed in 11 cases of prone group (52%) , this number was 18 (86,7%) in supine group (p=0,019). Stone-free rates were similar in both groups (supine m-PNL:90,5%, prone m-PNL:85,7%, p=0.634). Complications were minor in nature in the majority of the cases of both groups which resolved with supportive measures in a short period of time. However, there was a statistically significant difference regarding the location and number accesses between two groups (p=0,008). Simultaneous flexible URS was performed in 8 patients in the supine PNL group (<0,001). Conclusions Our current findings and the highly limited data reported in the literature indicate that as an established minimal invasive treatment alternative m-PNL procedure in supine position can also be performed with similar success and complication rates in pediatric population.

Introduction: Ureteral stone impaction can significantly affect the success of ureteroscopy (URS) in children. While the factors predicting impaction have been well studied in adults, data in children are limited. This study aimed to identify factors that predict ureteral stone impaction in children undergoing URS and to compare the success rates and complications based on the stone impaction status. Patients and Methods: Pediatric patients undergoing URS for ureteral stones were retrospectively reviewed. Impaction status of the stones was evaluated by radiological parameters and the children were divided into two groups based on the presence of stone impaction. Peri- and postoperative findings were comparatively evaluated in patients with or without stone impaction. Results: A total of 102 pediatric patients were included (40 with impacted stones, 62 with nonimpacted ureteral stones). The mean age was 9.3 ± 5.3 years. Univariate analysis showed significant differences between the groups in degree of hydronephrosis, presenting symptoms, stone density (HU), stone size, upper ureteral diameter, and that of ureteral wall thickness (UWT) ( p = 0.004, p = 0.044, p = 0.033, p = 0.005, p = 0.012, p = 0.000, respectively). Multivariate analysis revealed UWT as the only independent predictor of stone impaction, with a cutoff value of 2.63 mm showing 83% sensitivity and 82% specificity ( p = 0.000). The highest UWT value in the nonimpacted stone group was 3.1 mm. The mean operation time was found to be significantly longer in cases with impacted stones ( p = 0.000). Kids with impacted stones had lower mean success rate (impacted = 70%, nonimpacted = 88.7%) and higher mean rate of complications, longer duration of DJ-stenting, more anesthesia sessions ( p = 0.018, p = 0.019, p = 0.000 and p = 0.000, respectively). Conclusions: Similar to the adult cases, UWT could be used as a reliable parameter in predicting the impaction status of ureteral stones in pediatric patients. Impacted ureteral stones may reveal decreased success and higher complications rates during and after endoscopic stone surgery in these cases.

Introduction: Ultrasound (US)-guided puncture has the benefits of avoiding radiation and limiting the risk of visceral injury. We aimed to evaluate the results of two different renal access techniques during pediatric supine mini percutaneous nephrolithotomy (smPCNL) in a comparative manner. Patients and Methods: Data obtained from pediatric patients undergoing smPCNL by single surgeon between September 2021 and 2023 were reviewed retrospectively. Children were divided into two groups namely; biplanar 0°−90° fluoroscopy (Group-F) and US−fluoroscopy combined (Group-C). In all cases, preoperative, operative, and postoperative findings were recorded. Success was defined as the determination of either no (complete stone-free status) or < 4 mm residual fragments (CIRF) on US and X-ray (postoperative 3rd month) images. Complications were evaluated according to modified Clavien−Dindo classification. Results: Data of 54 patients with a mean age of 8.6 years (Group-F = 30, Group-C = 24) are reviewed. In addition to the similar success rates in both groups (Group-F = 86.7% Group-C = 87.5% p = 0.928), similar minor complications were noted in the majority of the cases. No child required transfusion and/or angioembolization. Although the fluoroscopy and operation time were lower in Group-C, the difference was not statistically significant. Conclusion: US–fluoroscopy combined access technique can be applied with similar success and complication rates in pediatric smPCNL. Ultimately, as experience is gained, this technique may lower radiation exposure, although this was not observed in the current study.

Many factors are considered to affect vascular physiology. It is known that one of the reasons for many diseases is a pathology at the microvascular level. Therefore, the relationship between endothelial dysfunction and many diseases is currently being investigated. The clinical evaluations of arterial stiffness have made it possible to perform necessary risk assessment regarding cardiovascular diseases. In this way, protective measures can be taken against microvascular pathologies in many organs. In this paper, we present a review of studies investigating the relationship between urological conditions and the cardio-ankle vascular index (CAVI), a marker of arterial stiffness. As with erectile dysfunction, some studies have shown that conditions such as lower urinary tract symptoms, overactive bladder, and chronic kidney disease are also associated with an elevated CAVI. The association of erectile dysfunction and chronic kidney disease with vascular pathologies has been clearly demonstrated. In addition, lower urinary tract symptoms may be the first sign of silent vascular dysfunction. Assessing arterial stiffness with CAVI can help prevent future cardiovascular events in these patients.