title: Retrograde intrarenal surgery monotherapy versus shock wave lithotripsy for stones 10 to 20 mm in preschool children: a prospective, randomized study.
abstract: OBJECTIVE
  We compared the outcome of retrograde intrarenal surgery monotherapy vs shock wave lithotripsy for stones 10 to 20 mm in preschool children.
  
  
  METHODS
  This prospective study included 60 children with a mean ± SD age of 2.4 ± 1.3 years. Patients were randomly divided into 2 groups. Group 1 underwent shock wave lithotripsy and group 2 underwent retrograde intrarenal surgery as monotherapy. Retrograde intrarenal surgery was started using a 7.5Fr semirigid ureteroscope (Storz®) and the holmium laser, and completed by the Flex X™2 flexible ureterorenoscope. A ureteral access sheath was not used and only hydrodilatation was performed. Patients were evaluated preoperatively by ultrasound and plain abdominopelvic x-ray. Followup was 3 months.
  
  
  RESULTS
  The stone-free rate after a single session treatment was 70% and 86.6% in groups 1 and 2, respectively. Mean operative time was 27.9 ± 3.5 and 40 ± 7.8 minutes, mean fluoroscopy exposure time was 60 ± 42 and 50 ± 35 seconds, and mean hospital stay was 6 ± 2 and 12 ± 8 hours, respectively. No major complication occurred in either group and no child in either group received blood transfusion. Nine group 1 patients needed a second shock wave lithotripsy session, of whom 2 required a third session. At 3 months the overall stone-free rate was 93.3% and 96.6% in groups 1 and 2, respectively.
  
  
  CONCLUSIONS
  Retrograde intrarenal surgery is an option for treating medium sized renal stones in preschool children with results comparable to those of shock wave lithotripsy and a safe short-term outcome.
authors.affiliation: Urology Department, Alexandria University, Alexandria, Egypt.
authors.forename: Ibrahim A
authors.initials: IA
authors.lastname: Mokhless
authors.affiliation: Urology Department, Alexandria University, Alexandria, Egypt. Electronic address: h_abdeldaeim@hotmail.com.
authors.forename: Hussein M
authors.initials: HM
authors.lastname: Abdeldaeim
authors.affiliation: Urology Department, Alexandria University, Alexandria, Egypt.
authors.forename: Ashraf
authors.initials: A
authors.lastname: Saad
authors.affiliation: Urology Department, Alexandria University, Alexandria, Egypt.
authors.forename: Abdel Rahman
authors.initials: AR
authors.lastname: Zahran
mesh_terms: D005260:Female; D006801:Humans; D007669:Kidney Calculi / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D008096:Lithotripsy; D017602:Lithotripsy, Laser; D008297:Male; D011446:Prospective Studies; D016896:Treatment Outcome; D018666:Ureteroscopy
keywords: calculi; endoscopes; kidney; laser; lithotripsy