Is mini-percutaneous nephrolithotomy a safe alternative to extracorporeal shockwave lithotripsy in pediatric age group in borderline stones? a randomized prospective study

  • Ahmed Farouk
  • Ahmed Tawfick
  • Mohamed Shoeb
  • Mahmoud A. Mahmoud
  • Diaa Eldin Mostafa
  • Mohamed Hasan
  • Hany M. Abdalla
Original Article
  • 8 Downloads

Abstract

Purpose

The extracorporeal shockwave lithotripsy (ESWL) remains the most common first line of treatment for renal stones in the pediatric population. The purpose of this study is to evaluate and compare the outcomes of the ESWL and mini-percutaneous nephrolithotomy (mini-PCNL).

Patients and methods

A total of 108 patients younger than 12 years of age with 1–2 cm single renal stone (pelvic or calyceal) were randomized into two groups, each containing 54 patients. Patients in group A were subjected to mini-PCNL using 16.5 Fr percutaneous sheath while those in group B underwent ESWL using Dornier Compact Sigma.

Results

The stone-free rate (SFR) after first session was 88.9% (48 cases) and 55.6% (30 cases) for groups A and B, respectively. The difference is highly statistically significant P = 0.006. Two patients (3.7%) in group A needed 2nd session of PCNL, while 18 patients (33.3%)in group B needed a 2nd session, of theses 18 patients six patients needed a 3rd session of ESWL. After the third session of ESWL and second look PCNL the stone-free rates were 92.59% (50 cases) and 88.89% (48 cases) for groups A and B, respectively, (P = 0.639), which is statistically insignificant. The mean hospital stay and fluoroscopy exposure were significantly longer in the mini-PCNL group. The complication rate in groups A and group B were (22.2%) and (14.8%), respectively, which is statistically insignificant (P = 0.484).

Conclusions

According to Clavien grade of complications mini-PCNL is a safe procedure, and after three session of ESWL, mini-PCNL has a similar stone-free rate with a lower retreatment rate. However, the mini-PCNL has more radiation exposure, and requires a longer hospital stay.

Keywords

Mini-percutaneous nephrolithotomy ESWL Extracorporeal shock wave lithotrips Pediatric renal stone Endourology 

Abbreviations

PCNL

Percutaneous nephrolithotomy

ESWL

Extracorporeal shockwave lithotripsy

YAG

Neodymium-doped yttrium aluminium garnet

CIRF

Clinically insignificant residual fragments

KUB

Kidneys, ureters and bladder

US

Ultrasonography

SFR

Stone-free rate

Notes

Author contributions

AT Project development, Data management, Manuscript writing and editing; AF Project development, Data management; MS Project development, Data management; MM Project development, Data management; DM Project development, Data management; MH Data collection, Data analysis; HA Project development, Data management.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

The research involving human participants

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Ethical approval

The study was approved by the local ethical committee of the hospital.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Ahmed Farouk
    • 1
  • Ahmed Tawfick
    • 1
  • Mohamed Shoeb
    • 1
  • Mahmoud A. Mahmoud
    • 1
  • Diaa Eldin Mostafa
    • 1
  • Mohamed Hasan
    • 1
  • Hany M. Abdalla
    • 1
  1. 1.Department of UrologyAin Shams University HospitalCairoEgypt

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