<![CDATA[Background: Mini-percutaneous nephrolithotomy (mini-PCNL) and extracorporeal shock wave lithotripsy (ESWL) are commonly used for pediatric renal stones; however, comparative evidence for stones measuring 10–20 mm remains limited and inconsistent. Objective: This systematic review and meta-analysis aimed to compare the efficacy and safety of mini-PCNL versus ESWL in children with renal stones <2 cm. Methods: PubMed/MEDLINE, Cochrane CENTRAL, and Wiley Online Library were searched following PRISMA 2020 guidelines. Comparative studies evaluating mini-PCNL and ESWL in pediatric renal stones <2 cm were included. Outcomes were analyzed using a DerSimonian–Laird random-effects model, while risk of bias was assessed using RoB 2 and ROBINS-I tools. Results: Four studies (three randomized controlled trials and one retrospective cohort study) involving 455 patients (226 mini-PCNL and 229 ESWL) were included. Mini-PCNL demonstrated a higher stone-free rate (RR 1.85, 95% CI 1.17–2.92) and lower retreatment rate (RR 0.19, 95% CI 0.07–0.50) compared with ESWL. However, sensitivity analysis showed reduced statistical certainty for stone-free rate (RR 1.59, 95% CI 0.79–3.23). Complication rates were comparable between groups (RR 1.22, 95% CI 0.86–1.73). Data on operative time and hospital stay were insufficient for pooled analysis. Risk of bias was high in randomized trials and moderate in the cohort study. Conclusion: Mini-PCNL may provide superior stone clearance and fewer retreatments than ESWL for pediatric renal stones <2 cm, but current evidence remains limited by study quality and heterogeneity. Further high-quality comparative studies are required.]]>
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