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14:07 - 14:10
S9-6
(PP)
EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY VERSUS MINI-PERCUTANEOUS
NEPHROLITHOTOMY FOR RENAL STONES IN INFANTS AND PRESCHOOL
CHILDREN: A COMPARATIVE STUDY
Mohammed Said ELSHEEMY, Kareem DAW, Waseem ABOULELA, Ahmed SHOUMAN, Ahmed SHOUKRY, Hany MORSI and
Hesham BADAWY
Cairo University, Urology department, Giza - Cairo, EGYPT
PURPOSE
To compare outcomes of mini-percutaneous nephrolithotomy(Miniperc) and SWL for renal stones in preschool-children.
MATERIAL AND METHODS
From January2010 to August2014, renal pelvic or lower-calyceal calculi sizing 10–25mm in children(≤6years) with
normal creatinine treated by SWL(64children) using Dornier electromagnetic DoLi S lithotripter or Miniperc(35children)
under general anesthesia were included. Miniperc was through 14F-renal access using 9.5Fr semirigid-ureteroscope with
Holmium:YAG laser Lithotripsy. Stone-free rates(SFR), re-treatment rate and complications were compared between
both groups and subgroups(renal pelvic and lower-calyceal stones).
RESULTS
Age, gender and stones parameters were similar in both groups and in pelvic(23Miniperc and 52SWL) and lower-
calyceal(12renal units in each procedure) subgroups. Stone size was 15(10-25)mm and16 (10-25)mm in SWL and
Miniperc, respectively(p=0.422). SFR after first session, and finally in Miniperc and SWL groups were
97.1%vs43.8%(p<0.001) and 97.1%vs81.2%(p=0.02); respectively. In renal pelvis, they were 100%vs50%(p<0.001)
and 100%vs84.6%(p=0.09); respectively. In lower calyx, they were 91.7%vs16.7%(p<0.001) and
91.7%vs66.7%(p=0.02); respectively. Retreatment rates in Miniperc and SWL were 2.9%vs50%(p<0.001),
0%vs46.2%(p<0.001) and 8.3%vs66.7%(p=0.009), in all patients, renal pelvic- and lower calyceal stones;
respectively. 12(18.8%)patients required third SWL session. No significant difference(p=0.159) was found in
complications in SWL(6.2%) and Miniperc(17.1%) groups and also in subgroups. Miniperc complications were bleeding
with blood transfusion(2.9%), renal pelvis perforation(2.9%), leakage(5.7%) and fever(5.7%). SWL complications were
steinstrasse treated conservatively(3.1%) or by ureteroscopy(3.1%). A stent was inserted for 1(2.9%)case of leakage
following Miniperc while other case was treated conservatively. There was no recurrence during follow-up (20-45months
in SWL vs 6-31months in Miniperc).
CONCLUSIONS
Miniperc has significantly higher SFR than SWL for renal pelvic and lower calyceal stones(10–25mm) in preschool
children with lower retreatment rate and without significant increase in complications.