Lower calyceal and renal pelvic stones in preschool children: A comparative study of mini‐percutaneous nephrolithotomy versus extracorporeal shockwave lithotripsy

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, v 2 -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.

Clinical effectiveness in the diagnosis and acute management of pediatric nephrolithiasis

“…When compared with SWL for children with renal stone burden of 1–2.5cm, mini-PCNL was found to be more efficacious with a higher stone-free rate although with one randomized trial noting longer operative time, higher radiation exposure, and more complications. 57,58 Similarly, Saad and associates noted a higher stone-free rate (96% vs. 71%) at the expense of higher complication rate in children with renal stone burden >2cm randomized to undergo PCNL compared with URS. 59 The authors noted a 14% blood transfusion rate with PCNL compared to 0% with URS.…”

Which is the best treatment of pediatric upper urinary tract stones among extracorporeal shockwave lithotripsy, percutaneous nephrolithotomy and retrograde intrarenal surgery: a systematic review

“…In total, 13 articles were included in this quantitative synthesis [15–27]. There were 3 randomized controlled trials [17, 21, 24] (RCTs) (LE: 2b), 1 prospective case controlled study [16] (LE: 3b) and 9 retrospective case controlled studies [15, 18–20, 22, 23, 25–27] (LE: 3b) (Table 1). Seven nonrandomized studies were relatively high (NOS: 6 of 9 points) and 3 nonrandomized studies were medium (NOS: 5 of 9 points) in methodological quality.…”

Update on Surgical Management of Pediatric Urolithiasis

“…Lower calyceal stones have a poorer clearance rate as compared to renal pelvic, upper, and mid calyceal stones (52). Lower calyceal stone clearance by ESWL is dependent on anatomical factors such as lower calyceal infundibular width, length, and infundibulopelvic angle (53, 54).…”

“…Retrospective comparative studies have indicated that mini PCNL provides at least similar stone-free rate for moderate-size stones in comparison to RIRS (61). ElSheemy et al also demonstrated superior results with mini PCNL (14FG) for renal calculi of 10–25 mm in preschool children in comparison to ESWL with comparable complication rates but a longer hospital stay (52).…”