Ahmed MNA. et al., 2026: Extracorporeal shock wave lithotripsy vs percutaneous nephrolithotomy, complication rate and recurrence rate in management of pediatric renal stone, a prospective randomized trial.

Ahmed MNA, Selmy GI, Deif HA, Elatreisy A, Wahsh AF, Salah E.
Arch Ital Urol Androl. 2025 Dec 24;97(4):14286. doi: 10.4081/aiua.2025.14286

Abstract

Background: The mini-percutaneous nephrolithotomy (PNL) technique has introduced notable advantages, establishing it as a compelling option compared to extracorporeal shock wave lithotripsy (SWL) in managing renal stones in the pediatric population. We aimed to compare the outcomes of both techniques as regards effectiveness, morbidity, and stone recurrence.

Methods: A prospective, randomized superiority trial included 128 pediatric patients with a solitary renal stone measuring 10-20 mm. Group I included patients who underwent mini-PNL (n=65), while Group II included those managed with SWL (n=63). The primary endpoint was the stone-free rate (SFR) eight weeks after the procedure, while the secondary endpoints were operative time, hospital stay, and postoperative complications. The stone recurrence rate was assessed at 2-year follow-up.

Results: The mean age of the patients ± SD was 8.48±4.08 years, and the mean size of the stones was 17.13±2.45 millimeters. The study arms had comparable demographics and stone characteristics. The mean operative time was significantly lower in Group I than in Group II (51.38±14.02 min vs 63.70±16.90 min, respectively; p=0.001). We reported a perioperative complication rate of 26.2% in Group I, compared to 20.6% in Group II, with a statistically insignificant difference (p=0.461). SFR was 93.8% and 41.3% for groups I and II, respectively (p<0.001). The stone recurrence was reported in 4 cases (6.1%) in Group I compared to 10 cases (15.8%) in Group II (p=0.005).

Conclusions: Our study demonstrates that Mini-PNL has a higher stone-free rate than SWL for managing renal stones of 10-20 mm in children. While both techniques have comparable complication rates, mini-PNL has higher intraoperative complications and longer hospital stays. Additionally, stone recurrence is more common after SWL compared to mini-PNL.

Comment Hans-Göran Tiselius

This prospective randomized comparison of pediatric use of mini-percutaneous nephrolithotomy and SWL was carried out on 65 and 63 children, respectively. The stone-free rate after mini-PNL with optical control of fragment removal was 94% compared with 42% for SWL.  In the latter patients, SWL was carried out with a piezoelectric device. This explains why only 3.2% of these patients were satisfactorily treated with only ONE treatment session. As many as 83% were treated three times.

It is not mentioned if any non-invasive methods for post-SWL removal of stones or fragments were used, but probably not. It is of note that four recurrences were recorded after 2 years in min-PNL patients and 10 in SWL treated patients. More than 70% of the children had hypercalciuria.

The interested reader can find additional interesting data in the article, but the marked difference in stone-free rates depends on the choice of SWL-method.

Hans-Göran Tiselius