Kumar A et al, 2015: 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
Kumar A, Kumar N, Vasudeva P, Kumar R, Jha SK, Singh H.
Department of Urology and Renal Transplant, VMMC and Safdarjung Hospital , New Delhi, India.
BACKGROUND AND PURPOSE: A prospective randomized study was performed comparing miniperc and shockwave lithotripsy (SWL) for treatment of radiopaque 1 to 2 cm lower caliceal renal calculi in children to evaluate safety and efficacy of these procedures.
PATIENTS AND METHODS: Pediatric patients (<15 years) with a single radiopaque lower caliceal renal stone 1 to 2 cm undergoing treatment between March 2012 and September 2013 in our department were randomized into two groups-group A, miniperc; group B, SWL. The two groups were compared statistically regarding patient demographic profile, 3-month stone-free rate (SFR), re-treatment rates, auxiliary procedures, and complications.
RESULTS: There were 106 patients enrolled in each group. The mean age (10.3 years vs 10.7 years, P=0.57) and stone size (12.7 mm vs 12.9 mm, P=0.31) were similar between group A and B patients. The re-treatment rate and auxiliary procedure rate were significantly greater in group B compared with group A (41.5% vs 2.8% and 14.2% vs 5.6%, respectively; P<0.001). The overall 3-month SFR was 94.3% for group A vs 83% for group B (P=0.03). The complication rate (20.7% vs 3.7%; P=0.01) and hospital stay (3.7 days vs 7.1 hours; P=0.01) was significantly higher in group A compared with group B. Blood transfusion was given in 10.3% patients in group A vs none in group B (P=0.01).
CONCLUSIONS: Miniperc is more efficacious than SWL for treatment of radiopaque lower caliceal renal calculi 1 to 2 cm in children in terms of higher SFR and lesser auxiliary and re-treatment rates. Miniperc, however, resulted in more complication, operative time, radiation exposure, and hospital stay.
J Endourol. 2015 Feb 26. [Epub ahead of print]
“ … we conducted this first prospective randomized comparative study (after thorough Medline and PubMed search, to the best of our knowledge) to compare safety and efficacy of these two procedures in the pediatric population”
Other significant differences besides those mentioned in the abstract were:
Operative and fluoroscopy times are very probably not the cumulative times which must be higher than reported.
The infundibulopelvic angle was 90 in 96 of the SWL patients. With the difference in the SFR the former would have been better off with miniperc.
The overall SFR rates do not differentiate between CIRF and non CIRF.
Despite this limited criticism this is a publication which adds substantial information to our knowledge. The data can be used to counsel parents when they have to choose the procedure for their child. One comment the authors made seems to be important for the counselling doctor: “All invasive procedure in patients younger than 14 years necessitate some kind of anesthesia, so if a treatment approach is likely to be unsuccessful because of any associated anomaly/metabolic factor, it is better to choose the procedure with the highest possible success rate in a single sitting.”