Alhefnawy MA. et al., 2026: Mini-Percutaneous Nephrolithotomy vs Extracorporeal Shock Wave Lithotripsy for Management of Renal Stones in Pediatric Age Group Less Than 6 Years with Renal Stones Less Than 20 mm. A Prospective, Randomized Trial.

Alhefnawy MA, Selmy GI, Salah E, Deif HA, Wahsh AF, Ahmad MNA, Eldib HA.
J Endourol. 2026 Mar 11:8927790261431003. doi: 10.1177/08927790261431003

Abstract

Background: Pediatric nephrolithiasis continues to pose a substantial clinical challenge in pediatric urology because of its elevated recurrence rate and elevated morbidity with risk of end-stage renal failure. The management of pediatric nephrolithiasis involves dietary modification, pharmacological therapy, and urological intervention, with the choice of treatment guided by stone size, location, and composition.

Objective: To evaluate the efficacy and safety of mini-percutaneous nephrolithotomy (mini-PCNL) and extracorporeal shock wave lithotripsy (SWL) for the management of renal stones measuring 1-2 cm in pediatrics.

Cases and methods: This prospective, randomized comparative research was conducted at the Department of Urology, Al-Azhar University Hospital, Assiut, Egypt, between December 2022 and November 2024. Sixty children with single renal stones were enrolled, with 30 undergoing SWL and 30 receiving mini-PCNL.

Results: Mini-PCNL achieved a significantly elevated stone-free rate (SFR, 93.33%) in contrast with SWL (33.33%) (p < 0.001). The SWL group also showed a higher rate of auxiliary approaches and retreatment. Overall complication rates were comparable.

Conclusion: Mini-PCNL is more effective than SWL for managing renal stones measuring 10-20 mm in children aged 6 months to 6 years. It provides an elevated SFR and lowers the likelihood of retreatment and hospital readmission, with a comparable safety profile.

Comment Peter Alken

I hate papers introducing today’s general perspectives of ESWL by quoting 22 years old references (1) on shockwave lithotripters that were originally build to treat gallbladder stones with ultrasound focusing  and I dislike papers using terms like “ongoing concern” or “concerns persist” when describing the complications or consequences of ESWL or PNL respectively and quoting 15- and 16-years old references. As a reader with limited time, I feel cheated.

The ESWL results were really poor: “20 units (66.6%) showed inadequate response: 18 cases (60%) subsequently underwent successful mini-PCNL” 5 studies with a similar study design but better results are discussed.). The literature is full of low-quality repetitions. What do editors and reviewers signalize by similar publication?

1 (Reference 2 in the present paper) Aksoy Y, Ozbey I, Atmaca AF, Polat O. Extracorporeal shock wave lithotripsy in children: Experience using a mpl-9000 lithotriptor. World J Urol 2004;22(2):115–119.

Peter Alken