title: Percutaneous Nephrolithotomy vs Retrograde Intrarenal Surgery for Large Renal Stones in Pediatric Patients: A Randomized Controlled Trial.
abstract: OBJECTIVE
  We compared outcomes of percutaneous nephrolithotomy and retrograde intrarenal surgery in the treatment of children with renal calculi larger than 2 cm.
  
  
  METHODS
  A total of 38 patients younger than 16 years with renal calculi larger than 2 cm were randomized to undergo percutaneous nephrolithotomy or retrograde intrarenal surgery between May 2011 and February 2014. Demographic data, stone criteria, operative technique, radiation time, complications, blood transfusion, hemoglobin decrease, stone-free rate and length of hospital stay were compared between the groups. Stone-free status was documented if there were no residual stones after 1 month.
  
  
  RESULTS
  The study included 43 renal units, of which 21 were subjected to retrograde intrarenal surgery and 22 to percutaneous nephrolithotomy. Operative time was comparable for both groups. Mean radiation time and hospital stay were longer after percutaneous nephrolithotomy (p<0.001). Stone-free rate was significantly lower after retrograde intrarenal surgery monotherapy vs percutaneous nephrolithotomy monotherapy (71% vs 95.5%, p=0.046). Patients in the percutaneous nephrolithotomy group had significantly more complications compared to the retrograde intrarenal surgery group (p=0.018). Three patients in the percutaneous nephrolithotomy group received blood transfusions, compared to none in the retrograde intrarenal surgery group (p=0.015).
  
  
  CONCLUSIONS
  For treatment of large or complex renal stones in pediatric patients percutaneous nephrolithotomy monotherapy has the advantage of better stone-free rates, while retrograde intrarenal surgery has the advantages of decreased radiation exposure, fewer complications and shorter hospital stay.
authors.affiliation: Urology Department, Alexandria Faculty of Medicine, Alexandria, Egypt; Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura (ARE-N), Egypt. Electronic address: karim.saad.md@gmail.com.
authors.forename: Karim S M
authors.initials: KS
authors.lastname: Saad
authors.affiliation: Urology Department, Alexandria Faculty of Medicine, Alexandria, Egypt; Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura (ARE-N), Egypt.
authors.forename: Mohamed Elsaid
authors.initials: ME
authors.lastname: Youssif
authors.affiliation: Urology Department, Alexandria Faculty of Medicine, Alexandria, Egypt; Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura (ARE-N), Egypt.
authors.forename: Seif
authors.initials: S
authors.lastname: Al Islam Nafis Hamdy
authors.affiliation: Urology Department, Alexandria Faculty of Medicine, Alexandria, Egypt; Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura (ARE-N), Egypt.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Fahmy
authors.affiliation: Urology Department, Alexandria Faculty of Medicine, Alexandria, Egypt; Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura (ARE-N), Egypt.
authors.forename: Ahmed Gamal
authors.initials: AG
authors.lastname: El Din Hanno
authors.affiliation: Urology Department, Alexandria Faculty of Medicine, Alexandria, Egypt; Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura (ARE-N), Egypt.
authors.forename: Ahmed R
authors.initials: AR
authors.lastname: El-Nahas
mesh_terms: D002648:Child; D002675:Child, Preschool; D005260:Female; D005334:Fever / Q000209:etiology; D005500:Follow-Up Studies; D006452:Hemoglobinometry; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D006876:Hydrothorax / Q000209:etiology; D015907:Hysteroscopy / Q000379:methods*; D007082:Ileum / Q000293:injuries; D007669:Kidney Calculi / Q000601:surgery*; D017602:Lithotripsy, Laser / Q000379:methods; D008297:Male; D009403:Nephrostomy, Percutaneous / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology*; D015607:Stents
keywords: kidney calculi; pediatrics; ureteroscopy; urinary calculi; urologic surgical procedures