The Stone Kidney Size (SKS) Score Breakthrough: A Simple Yet Powerful Tool to Predict Success and Safety Outcomes in Pediatric Mini Percutaneous Nephrolithotomy (PCNL)

SKS Score in Pediatric Mini-PCNL Outcomes

Authors

  • Yasra Faheem Department of Urology, Tabba Kidney Institute, Karachi, Pakistan
  • Sharjeel Saulat Qazi Department of Urology, Tabba Kidney Institute, Karachi, Pakistan
  • Jahanzeb Shaikh Department of Urology, Tabba Kidney Institute, Karachi, Pakistan
  • Umber Rasheed Department of Urology, Tabba Kidney Institute, Karachi, Pakistan
  • Ashba Mushtaq Department of Urology, Tabba Kidney Institute, Karachi, Pakistan
  • Subhan Ahmed Sajjad Department of Urology, Tabba Kidney Institute, Karachi, Pakistan
  • Haris Ali Khan Department of Surgery, University Hospital Coventry and Warwickshire, NHS Trust, United Kingdom

DOI:

https://doi.org/10.54393/pjhs.v7i7.4017

Keywords:

Pediatric Nephrolithiasis, Mini Percutaneous Nephrolithotomy, SKS Score, Logistic Regression

Abstract

Mini percutaneous nephrolithotomy (PCNL) is now considered one of the important treatment modalities for large renal stones or stones that are refractory to other treatments. Objective: To evaluate the predictive accuracy of the Stone Kidney Size (SKS) score for the prediction of the success rate of mini PCNL in the pediatric population. Methods: A prospective cross-sectional validation study was conducted at Tabba Kidney Hospital for a period of 7 months (from June 2025 to December 2025).  A total of 124 children aged 1–14 years with unilateral renal stones were included. SKS score was calculated preoperatively using Ultrasound KUB based on the number of stones and Stone Kidney Index (SKI). Statistical analysis included chi-square test, logistic regression, and ROC curve analysis. Results: The mean age of the participants was 6.05 ± 3.32 years, and 67.7% male predominance was observed. Overall, the stone clearance rate was 81.4%. A total of 19% patients experienced postoperative complications, with a higher proportion in patients with a SKS score of ≥ 6 (P=0.034). The SKS score was found to be an independent predictor of incomplete stone clearance (p<0.001) with good predictive accuracy on ROC analysis. Conclusions: The SKS score is a simple, non-invasive, and reproducible tool that could be evaluated preoperatively with the use of Ultrasound KUB. It has good predictive ability for stone clearance and postoperative complications.

References

Zeng G, Zhu W, Somani B, Choong S, Straub M, Maroccolo MV et al. International Alliance of Urolithiasis (IAU) Guidelines on the Management of Pediatric Urolithiasis. Urolithiasis. 2024 Sep; 52(1): 124. doi: 10.1007/s00240-024-01621-z. DOI: https://doi.org/10.1007/s00240-024-01621-z

Kovacevic L. Diagnosis and Management of Nephrolithiasis in Children. Pediatric Clinics. 2022 Dec; 69(6): 1149-1164. doi: 10.1016/j.pcl.2022.07.008. DOI: https://doi.org/10.1016/j.pcl.2022.07.008

Al-Naggar K, Aljuma’ai N, Ahmed F, Alnadhari I, Al-Hagri A, Alhakamy M et al. Prevalence of Urolithiasis in Children from the EMRO Region: A Systematic Review and Meta-Analysis. Journal of Emergency Medicine, Trauma and Acute Care. 2025 Sep; 2025(3): 40. doi: 10.5339/jemtac.2025.40. DOI: https://doi.org/10.5339/jemtac.2025.40

Mahmood SN, Falah B, Ahmed C, Fakhralddin S, Tawfeeq H. Is Mini Percutaneous Nephrolithotomy a Game Changer for the Treatment of Renal Stones in Children? European Urology Open Science. 2022 Mar; 37: 45-9. doi: 10.1016/j.euros.2021.12.014. DOI: https://doi.org/10.1016/j.euros.2021.12.014

Gnech M, Van Uitert A, Kennedy U, Skott M, Zachou A, Burgu B et al. European Association of Urology/European Society for Paediatric Urology Guidelines on Paediatric Urology: Summary of the 2024 Updates. European Urology. 2024 Nov; 86(5): 447-456. doi: 10.1016/j.euros.2021.12.014. DOI: https://doi.org/10.1016/j.eururo.2024.03.025

Jones P, Hawary A, Beck R, Somani BK. Role of Mini-Percutaneous Nephrolithotomy in the Management of Pediatric Stone Disease: A Systematic Review of Literature. Journal of Endourology. 2021 May; 35(5): 728-735. doi: 10.1089/end.2020.0743. DOI: https://doi.org/10.1089/end.2020.0743

Dede O, Sancaktutar AA, Dağguli M, Utangaç M, Baş O, Penbegul N. Ultra-Mini-Percutaneous Nephrolithotomy in Pediatric Nephrolithiasis: Both Low Pressure and High Efficiency. Journal of Pediatric Urology. 2015 Oct; 11(5): 253. doi: 10.1016/j.jpurol.2015.03.012. DOI: https://doi.org/10.1016/j.jpurol.2015.03.012

Jackman SV, Docimo SG, Cadeddu JA, Bishoff JT, Kavoussi LR, Jarrett TW. The “Mini-Perc” Technique: A Less Invasive Alternative to Percutaneous Nephrolithotomy. World Journal of Urology. 1998 Dec; 16(6): 371-374. doi: 10.1007/s003450050083. DOI: https://doi.org/10.1007/s003450050083

Fang H, Wang Z, Wei K, Liu X, Wu S, Hua Y, Lin T, He D, Wei G, Zhang D. Safety and Efficacy of Standard Vs. Tubeless Percutaneous Nephrolithotomy in Pediatric Populations: An Updated Systematic Review and Meta-Analysis. BioMed Central Urology. 2025 May; 25(1): 110. doi: 10.1186/s12894-025-01798-4. DOI: https://doi.org/10.1186/s12894-025-01798-4

Chen YH, Li WM, Juan YS, Huang TY, Wang YC, Lee HY. A Comparison of STONE Nephrolithometry Scoring System, Guy’s Stone Score, and Seoul National University Renal Stone Complexity (S-Resc) in Predicting Mini-PCNL Stone-Free Rate. Urolithiasis. 2024 Jan; 52(1): 19. doi: 10.1007/s00240-023-01499-3. DOI: https://doi.org/10.1007/s00240-023-01499-3

He Q, Huang Q, Hou B, Hao Z. Prediction of Percutaneous Nephrolithotomy Outcomes and Flexible Ureteroscopy Outcomes Using Nephrolithometry Scoring Systems. International Urology and Nephrology. 2024 May; 56(5): 1585-1593. doi: 10.1007/s11255-023-03847-z. DOI: https://doi.org/10.1007/s11255-023-03847-z

Aslan H, Senocak C, Haberal HB, Guvenir FG, Ibis MA, Sadioglu FE et al. Validation of Stone-Kidney Size Score to Predict Outcome and Complications of Pediatric Percutaneous Nephrolithotomy. Journal of Pediatric Urology. 2024 Dec; 20(6): 1026-1033. doi: 10.1016/j.jpurol.2024.07.030. DOI: https://doi.org/10.1016/j.jpurol.2024.07.030

Hughes SF, Moyes AJ, Jones K, Bell C, Duckett A, Moussa A, Shergill I. Pre-and Peri-Operative Clinical Information, Physiological Observations and Outcome Measures Following Flexible Ureterorenoscopy (FURS), for the Treatment of Kidney Stones. A Single-Centre Observational Clinical Pilot Study In 51 Patients. BioMed Central Urology. 2022 Jul; 22(1): 104. doi: 10.1186/s12894-022-01053-0. DOI: https://doi.org/10.1186/s12894-022-01053-0

Altunkol A, Alma E, Anıl H, Özbilen MH, Aksay B, Deniz ME. Assessing the Predictive Value of Scoring Systems for Stone-Free Success Outcomes in Pediatric Mini Percutaneous Nephrolithotomy: A Comprehensive Retrospective Analysis. Urolithiasis. 2025 May; 53(1): 90. doi: 10.1007/s00240-025-01762-9. DOI: https://doi.org/10.1007/s00240-025-01762-9

Raghavan VR, Porter JJ, Monuteaux MC, Neuman MI, Nelson KA. Imaging trends and surgical outcomes for nephrolithiasis in the pediatric emergency department. The American Journal of Emergency Medicine. 2025 Jun; 92: 104-108. doi: 10.1016/j.ajem.2025.03.014. DOI: https://doi.org/10.1016/j.ajem.2025.03.014

Ost MC. Treatment of Pediatric Stone Disease Driven by Age and Stone Size. JAMA Network Open. 2025 Jun; 8(6): 2516759. doi: 10.1001/jamanetworkopen.2025.16759. DOI: https://doi.org/10.1001/jamanetworkopen.2025.16759

Khan W, Khan TS, Khan RA, Khalid M, Ahmad A, Khan AI. Efficacy of Percutaneous Nephrolithotomy in Pediatric Renal Stone Clearance in Khyber Pakhtunkhwa: A Cross-Sectional Analytical Study: Percutaneous Nephrolithotomy in Pediatric Renal Stone Clearance. Pakistan Journal of Health Sciences. 2025 Jul: 209-214. doi: 10.54393/pjhs.v6i7.3344. DOI: https://doi.org/10.54393/pjhs.v6i7.3344

Baltaci KE, Hazir B, Altan M, Bozaci AC, Gasimov K, Tekgul S et al. Assesment of Factors Affecting Outcome of Mini-PCNL by Single-Shot Dilatation in Pediatric Patients. Pediatric Surgery International. 2025 Sep; 41(1): 299. doi: 10.1007/s00383-025-06198-1. DOI: https://doi.org/10.1007/s00383-025-06198-1

Mazzon G, Claps F, Pavan N, Choong S, Zeng G, Wu W et al. Reliability of Nephrolithometric Nomograms in Patients Treated with Minimally Invasive Percutaneous Nephrolithotomy: A Precision Study. Asian Journal of Urology. 2023 Jan; 10(1): 70-80. doi: 10.1016/j.ajur.2022.02.010. DOI: https://doi.org/10.1016/j.ajur.2022.02.010

Tahir R, Bakar A, Khan UU, Imran M, Ullah H. Safety and Efficacy of Mini-Percutaneous Nephrolithotomy (mini PCNL) in Pediatric Patients with Staghorn Stone: A Single Center Study in Pakistan. 2024 May: 1-12. doi: 10.21203/rs.3.rs-4414321/v1. DOI: https://doi.org/10.21203/rs.3.rs-4414321/v1

Çitamak B, Dogan HS, Ceylan T, Hazir B, Bilen CY, Sahin A, Tekgül S. A New Simple Scoring System for Prediction of Success and Complication Rates in Pediatric Percutaneous Nephrolithotomy: Stone-Kidney Size Score. Journal of Pediatric Urology. 2019 Feb; 15(1): 67. doi: 10.1016/j.jpurol.2018.09.019. DOI: https://doi.org/10.1016/j.jpurol.2018.09.019

Mushtaq A, Wani S, Shaheen FA, Hamid A, Khawaja AR, Malik SA, Para SA, Mehdi S, Shaheen F, Khawaja A, Para SA. Evaluation of the GUYS, STONE, and S-ReSC Scores in Predicting the Outcomes of Mini-Percutaneous Nephrolithotomy: A Prospective Study. Cureus. 2025 Apr; 17(4): 1-11. doi: 10.7759/cureus.82723. DOI: https://doi.org/10.7759/cureus.82723

Polat S, Yarimoglu S, Koras O, Sahan M, Sefik E, Bozkurt IH, Degirmenci T. Comparison of Guy's, STONE, and CROES Scoring Systems for Predicting Percutaneous Nephrolithotomy Outcomes in Elderly Patients. Journal of the College of Physicians and Surgeons Pakistan. 2021 Mar; 31(3): 307-313. doi: 10.29271/jcpsp.2021.03.307. DOI: https://doi.org/10.29271/jcpsp.2021.03.307

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Published

2026-07-31
CITATION
DOI: 10.54393/pjhs.v7i7.4017
Published: 2026-07-31

How to Cite

Faheem, Y., Qazi, S. S., Shaikh, J., Rasheed, U., Mushtaq, A., Sajjad, S. A., & Khan, H. A. (2026). The Stone Kidney Size (SKS) Score Breakthrough: A Simple Yet Powerful Tool to Predict Success and Safety Outcomes in Pediatric Mini Percutaneous Nephrolithotomy (PCNL): SKS Score in Pediatric Mini-PCNL Outcomes. Pakistan Journal of Health Sciences, 7(7), 85–91. https://doi.org/10.54393/pjhs.v7i7.4017

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