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ElSheemy MS et al 2016: Lower calyceal and renal pelvic stones in preschool children: A comparative study of mini-percutaneous nephrolithotomy versus extracorporeal shockwave lithotripsy.

ElSheemy MS, Daw K, Habib E, Aboulela W, Fathy H, Shouman AM, El Ghoneimy M, Shoukry AI, Morsi HA, Badawy H.
Division of Pediatric Urology, Aboul-Riche Children's Hospital, Cairo University, Cairo, Egypt.

Abstract

OBJECTIVES: To compare outcomes of the mini-percutaneous nephrolithotripsy technique and extracorporeal shockwave lithotripsy for lower calyceal and renal pelvic stones in preschool children.
METHODS: From January 2010 to December 2014, single renal pelvic or lower calyceal calculi 10-25 mm in size in children (age ≤6 years) treated by either extracorporeal shockwave lithotripsy (64 patients) or the mini-percutaneous nephrolithotripsy technique (54 patients) were included. Extracorporeal shockwave lithotripsy was carried out by using a Dornier electromagnetic lithotripter. The mini-percutaneous nephrolithotripsy technique was through 14-Fr renal access using a 9.5-Fr semirigid ureteroscope with holmium:yttrium aluminium garnet lithotripsy. The two study groups were compared using Mann-Whitney, χ2 -test or Fisher's exact test.
RESULTS: Stone parameters were similar in the mini-percutaneous nephrolithotripsy technique and extracorporeal shockwave lithotripsy groups in all patients, and in the pelvic (39 Miniperc, 52 extracorporeal shockwave lithotripsy) and lower calyceal (15 Miniperc, 12 extracorporeal shockwave lithotripsy) subgroups. Stone-free rates in the mini-percutaneous nephrolithotripsy technique and extracorporeal shockwave lithotripsy groups were 88.9% versus 43.8% (P < 0.001) and 94.4% versus 81.2% (P = 0.032) after first and last sessions, respectively. In the renal pelvis, they were 87.2% versus 50% (P < 0.001) and 94.9% versus 84.6% (P = 0.179), whereas in the lower calyx, they were 93.3% versus 16.7% (P < 0.001) and 93.3% versus 66.7% (P = 0.139) after first and last sessions, respectively. Retreatment rates in the mini-percutaneous nephrolithotripsy technique versus extracorporeal shockwave lithotripsy were 7.4% versus 50% (P < 0.001), 7.7% versus 46.2% (P < 0.001), and 6.7% versus 66.7% (P = 0.003) in all patients, renal pelvic and lower calyceal stones, respectively. No significant difference was found in complications (P = 0.521). Auxiliary procedures were required in 9.4% and 1.9% of children in the extracorporeal shockwave lithotripsy and mini-percutaneous nephrolithotripsy technique groups, respectively.
CONCLUSIONS: The mini-percutaneous nephrolithotripsy technique has significantly higher stone-free rates than extracorporeal shockwave lithotripsy for renal pelvic and lower calyceal stones (10-25 mm), with a lower retreatment rate and without a significant increase in complications. 

Int J Urol. 2016 May 13. doi: 10.1111/iju.13093. [Epub ahead of print]

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Comments 1

Hans-Göran Tiselius on Wednesday, 05 October 2016 10:59

In this comparative evaluation of SWL and mini-PNL in children, the authors came to the conclusion that the latter treatment modality should be preferred because of better results. The presented data also fully support that conclusion. It is my impression, however, that the stone-free rates with SWL in these young children were lower than expected, particularly for stones located in the renal pelvis. It is also my own experience that well disintegrated stone material is cleared very efficiently after SWL in this age group. Repeated sessions might accordingly be required in only a small fraction of the children.

For comparison I have added some results from recent publications showing that the results and treatment efforts vary considerably:

http://storzmedical.com/images/blog/ElSheemy_MS.jpg

References
1. Turna B, Tekin A, Yağmur İ, Nazlı O
Extracorporeal shock wave lithotripsy in infants less than 12-month old.
Urolithiasis. 2015 Dec 30. [Epub ahead of print]
2. Dogan HS, Altan M, Citamak B, Bozaci AC, Karabulut E, Tekgul S.
A new nomogram for prediction of outcome of pediatric shock-wave lithotripsy.
J Pediatr Urol. 2015 11(2):84.e1-6.
3. Kumar A, Kumar N, Vasudeva P, Kumar R, Jha SK, Singh H
A Single Center Experience Comparing Miniperc and Shockwave Lithotripsy for Treatment of Radiopaque 1-2 cm Lower Caliceal Renal Calculi in Children: A Prospective Randomized Study.
J Endourol. 2015 29(7):805-9
4. Adanur S, Ziypak T, Yılmaz AH, Kocakgol H, Aksoy M, Yapanoglu T, Polat O, Aksoy Y.
Extracorporeal shockwave lithotripsy under sedoanalgesia for treatment of kidney stones in infants: a single-center experience with 102 cases.
Int Urol Nephrol. 2014; 46(11):2095-101
5. Badawy AA, Saleem MD, Abolyosr A, Aldahshoury M, Elbadry MS, Abdalla MA, Abuzeid AM. Extracorporeal shock wave lithotripsy as first line treatment for urinary tract stones in children: outcome of 500 cases.
Int Urol Nephrol. 2012;44(3):661-6.
6. Göktaş C, Akça O, Horuz R, Gökhan O, Albayrak S, Sarica K
Does child's age affect interval to stone-free status after SWL? A critical analysis.
Urology. 2012; 79(5):1138-42.

In this comparative evaluation of SWL and mini-PNL in children, the authors came to the conclusion that the latter treatment modality should be preferred because of better results. The presented data also fully support that conclusion. It is my impression, however, that the stone-free rates with SWL in these young children were lower than expected, particularly for stones located in the renal pelvis. It is also my own experience that well disintegrated stone material is cleared very efficiently after SWL in this age group. Repeated sessions might accordingly be required in only a small fraction of the children. For comparison I have added some results from recent publications showing that the results and treatment efforts vary considerably: [img]http://storzmedical.com/images/blog/ElSheemy_MS.jpg[/img] References 1. Turna B, Tekin A, Yağmur İ, Nazlı O Extracorporeal shock wave lithotripsy in infants less than 12-month old. Urolithiasis. 2015 Dec 30. [Epub ahead of print] 2. Dogan HS, Altan M, Citamak B, Bozaci AC, Karabulut E, Tekgul S. A new nomogram for prediction of outcome of pediatric shock-wave lithotripsy. J Pediatr Urol. 2015 11(2):84.e1-6. 3. Kumar A, Kumar N, Vasudeva P, Kumar R, Jha SK, Singh H A Single Center Experience Comparing Miniperc and Shockwave Lithotripsy for Treatment of Radiopaque 1-2 cm Lower Caliceal Renal Calculi in Children: A Prospective Randomized Study. J Endourol. 2015 29(7):805-9 4. Adanur S, Ziypak T, Yılmaz AH, Kocakgol H, Aksoy M, Yapanoglu T, Polat O, Aksoy Y. Extracorporeal shockwave lithotripsy under sedoanalgesia for treatment of kidney stones in infants: a single-center experience with 102 cases. Int Urol Nephrol. 2014; 46(11):2095-101 5. Badawy AA, Saleem MD, Abolyosr A, Aldahshoury M, Elbadry MS, Abdalla MA, Abuzeid AM. Extracorporeal shock wave lithotripsy as first line treatment for urinary tract stones in children: outcome of 500 cases. Int Urol Nephrol. 2012;44(3):661-6. 6. Göktaş C, Akça O, Horuz R, Gökhan O, Albayrak S, Sarica K Does child's age affect interval to stone-free status after SWL? A critical analysis. Urology. 2012; 79(5):1138-42.
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