Treatment of renal stones in children: a comparison between percutaneous nephrolithotomy and shock wave lithotripsy.
OBJECTIVE
We compared the results of percutaneous nephrolithotomy and shock wave lithotripsy for the treatment of 1 to 2 cm renal stones in children.


METHODS
The study included 166 children with renal stones 1 to 2 cm. A total of 75 patients (82 kidneys) were treated with percutaneous nephrolithotomy and 91 (93 kidneys) were treated with shock wave lithotripsy. Mean followup was 31 +/- 10 months (range 6 to 84). Both groups were compared regarding stone-free rate, re-treatment rate, complications and incidence of stone recurrence.


RESULTS
Both groups were comparable regarding preoperative characteristics. Of the units treated with percutaneous nephrolithotomy 4 (4.9%) were associated with minor complications. Stone-free rate after a single session of percutaneous nephrolithotomy was 86.6% (71 units), and the remaining 11 kidneys with residual stones were successfully treated with repeat percutaneous nephrolithotomy in 7 and shock wave lithotripsy in 4. Therefore, a total of 78 units (95%) were stone-free after percutaneous nephrolithotomy monotherapy, and the overall stone-free rate at 3 months was 100%. Of the patients undergoing shock wave lithotripsy 1 (1.1%) had development of steinstrasse and was successfully treated with ureteroscopy. The overall re-treatment rate after shock wave lithotripsy was 55%. A total of 79 units (84.9%) were stone-free after shock wave lithotripsy monotherapy, whereas 7 (7.5%) with no gross response to treatment were treated with percutaneous nephrolithotomy and 7 with insignificant stones less than 4 mm were followed. Therefore, the overall stone-free rate at 3 months was 92.5%. The differences in stone-free rates and re-treatment rates significantly favored percutaneous nephrolithotomy, while the incidence of complications and stone recurrence at last followup were not significantly different between the groups.


CONCLUSIONS
For treatment of 1 to 2 cm renal stones in children percutaneous nephrolithotomy is better than shock wave lithotripsy, yielding higher stone-free and lower re-treatment rates.
Shokeir
Ahmed A
AA
Urology and Nephrology Center, Mansoura University, Mansoura, Egypt. ahmedshokeir@hotmail.com
Sheir
Khaled Z
KZ
El-Nahas
Ahmed R
AR
El-Assmy
Ahmed M
AM
Eassa
Waleed
W
El-Kappany
Hamdy A
HA
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007669:Kidney Calculi / Q000628:therapy*; D008096:Lithotripsy; D008297:Male; D009403:Nephrostomy, Percutaneous; D012189:Retrospective Studies