World Journal of Urology

, Volume 36, Issue 7, pp 1139–1147 | Cite as

Is mini-percutaneous nephrolithotomy a safe alternative to extracorporeal shockwave lithotripsy in pediatric age group in borderline stones? a randomized prospective study

  • Ahmed Farouk
  • Ahmed TawfickEmail author
  • Mohamed Shoeb
  • Mahmoud A. Mahmoud
  • Diaa Eldin Mostafa
  • Mohamed Hasan
  • Hany M. Abdalla
Original Article



The extracorporeal shockwave lithotripsy (ESWL) remains the most common first line of treatment for renal stones in the pediatric population. The purpose of this study is to evaluate and compare the outcomes of the ESWL and mini-percutaneous nephrolithotomy (mini-PCNL).

Patients and methods

A total of 108 patients younger than 12 years of age with 1–2 cm single renal stone (pelvic or calyceal) were randomized into two groups, each containing 54 patients. Patients in group A were subjected to mini-PCNL using 16.5 Fr percutaneous sheath while those in group B underwent ESWL using Dornier Compact Sigma.


The stone-free rate (SFR) after first session was 88.9% (48 cases) and 55.6% (30 cases) for groups A and B, respectively. The difference is highly statistically significant P = 0.006. Two patients (3.7%) in group A needed 2nd session of PCNL, while 18 patients (33.3%)in group B needed a 2nd session, of theses 18 patients six patients needed a 3rd session of ESWL. After the third session of ESWL and second look PCNL the stone-free rates were 92.59% (50 cases) and 88.89% (48 cases) for groups A and B, respectively, (P = 0.639), which is statistically insignificant. The mean hospital stay and fluoroscopy exposure were significantly longer in the mini-PCNL group. The complication rate in groups A and group B were (22.2%) and (14.8%), respectively, which is statistically insignificant (P = 0.484).


According to Clavien grade of complications mini-PCNL is a safe procedure, and after three session of ESWL, mini-PCNL has a similar stone-free rate with a lower retreatment rate. However, the mini-PCNL has more radiation exposure, and requires a longer hospital stay.


Mini-percutaneous nephrolithotomy ESWL Extracorporeal shock wave lithotrips Pediatric renal stone Endourology 



Percutaneous nephrolithotomy


Extracorporeal shockwave lithotripsy


Neodymium-doped yttrium aluminium garnet


Clinically insignificant residual fragments


Kidneys, ureters and bladder




Stone-free rate


Author contributions

AT Project development, Data management, Manuscript writing and editing; AF Project development, Data management; MS Project development, Data management; MM Project development, Data management; DM Project development, Data management; MH Data collection, Data analysis; HA Project development, Data management.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

The research involving human participants

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Ethical approval

The study was approved by the local ethical committee of the hospital.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Tasian GE, Copelovitch L (2014) Evaluation and medical management of kidney stones in children. J Urol 192:1329–1336CrossRefPubMedGoogle Scholar
  2. 2.
    Sabnis RB, Chhabra JS, Ganpule AP, Abrol S, Desai MR (2014) Current role of PCNL in pediatric urolithiasis. Curr Urol Rep 15:423CrossRefPubMedGoogle Scholar
  3. 3.
    Kolla SB, Wadhwa P, Aron M (2006) Current status of minimally invasive management of pediatric upper urinary tract calculi. J Indian Assoc Pediatr Surg 11(2):73CrossRefGoogle Scholar
  4. 4.
    Stamatiou KN, Heretis I, Takos D, Papadimitriou V, Sofras F (2010) Extracorporeal shock wave lithotripsy in the treatment of pediatric urolithiasis: a single institution experience, Department of Urology, School of Medicine, University of Crete, Crete, Greece. Int Braz J Urol 36:724–731CrossRefPubMedGoogle Scholar
  5. 5.
    Muslumanoglu AY, Tefekli A, Sarilar O et al (2003) (2003): extracorporeal shock wave lithotripsy as first line treatment alternative for urinary tract stones in children: A large scale retrospective analysis. J Urol 170:2405–2408CrossRefPubMedGoogle Scholar
  6. 6.
    Smaldone MC, Docimo SG, Ost MC (2010) Contemporary surgical management of pediatric urolithiasis. Urol Clin North Am 37:253–267CrossRefPubMedGoogle Scholar
  7. 7.
    Shu KL, Tai D, Chau L, Fung B (2006) Minimally invasive percutaneous nephrolithotomy (MPCNL) according to the Chinese method, interventional management of urological diseases. Recent Adv Endourol 8:41–63CrossRefGoogle Scholar
  8. 8.
    Skolarikos A, de la Rosette J (2008) Prevention and treatment of complications following percutaneous nephrolithotomy. Curr Opin Urol 18:229–234CrossRefPubMedGoogle Scholar
  9. 9.
    Guven S, Istanbulluoglu O, Gul U, Ozturk A, Celik H, Aygun C, Ozdemir U, Ozturk B, Ozkardes H, Kilinc M (2011) Successful percutaneous nephrolithotomy in children: multicenter study on current status of its use, efficacy and complications using Clavien classification. J Urol 185:1419–1424CrossRefPubMedGoogle Scholar
  10. 10.
    Zeng GL, Jia J, Zhao Z, Wu W, Zhao Z, Zhong W (2012) Treatment of renal stones in infants: comparing extracorporeal shock wave lithotripsy and mini-percutaneous nephrolithotomy. Urol Res 40(5):599–603CrossRefPubMedGoogle Scholar
  11. 11.
    Akin Y, Yucel S (2014) Long-term effects of pediatric extracorporeal shockwave lithotripsy on renal function. Res Rep Urol 6:21–25PubMedPubMedCentralGoogle Scholar
  12. 12.
    Ozden E, Mercimek MN (2016) Percutaneous nephrolithotomy in pediatric age group: assessment of effectiveness and complications. World J Nephrol 5(1):84–89CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Unsal A, Resorlu B, Kara C et al (2010) Safety and efficacy of percutaneous nephrolithotomy in infants, preschool age, and older children with different sizes of instruments. Urology 76:247–252CrossRefPubMedGoogle Scholar
  14. 14.
    Samad L, Qureshi S, Zaidi ZJ (2007) Does percutaneous nephrolithotomy in children cause significant renal scarring? Pediatric Urol 3:36–39CrossRefGoogle Scholar
  15. 15.
    D’Souza N, Paul S (2016) Mini percutaneous nephrolithotomy for renal calculi in pediatric patients: a review of twenty cases. Urol Ann 8:16–19CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Karatag T, Tepeler A, Silay MS, Bodakci MN, Buldu I, Daggulli M, Hatipoglu NK, Istanbulluoglu MO, Armagan A (2015) A comparison of 2 percutaneous nephrolithotomy techniques for the treatment of pediatric kidney stones of sizes 10–20 mm: microperc vs miniperc. Urology 85(5):1015–1018CrossRefPubMedGoogle Scholar
  17. 17.
    El-Sheemy MS, Daw K, Habib E, Aboulela W, Fathy H, Shouman AM, El Ghoneimy M, Shoukry AI, Morsi HA, Badawy H (2016) Lower calyceal and renal pelvic stones in preschool children: a comparative study of mini-percutaneous nephrolithotomy versus extracorporeal shockwave lithotripsy, Division of Pediatric Urology, Aboul-Riche Children’s Hospital, Cairo University, Cairo, Egypt. Int J Urol 23(7):564–570CrossRefGoogle Scholar
  18. 18.
    Badawy AA, Saleem MD, Abolyosr A, Aldahshoury M, Elbadry MS, Abdalla MA (2012) Extracorporeal shock wave lithotripsy as first line treatment for urinary tract stones in children: outcome of 500 cases. Int Urol Nephrol 44:661–666CrossRefPubMedGoogle Scholar
  19. 19.
    Tze MW, Kidger L, Kennish S, Irving H, Najmaldin A (2013) MINI PCNL in a pediatric population. Cardiovasc Intervent Radiol 36:249–254Google Scholar
  20. 20.
    Zeng G, Zhao Z, Wan S, Zhong W, Wu W (2013) Comparison of children versus adults undergoing mini-percutaneous nephrolithotomy: large-scale analysis of a single institution. PLoS One 8:e66850CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Resorlu B, Unsal A, Tepeler A, Atis G, Tokatli Z, Oztuna D, Armagan A (2012) Comparison of retrograde intrarenal surgery and mini-percutaneous nephrolithotomy in children with moderate-size kidney stones: results of multi-institutional analysis. Urology 80:519–523CrossRefPubMedGoogle Scholar
  22. 22.
    Hatipoglu NK, Sancaktutar AA, Tepeler A, Bodakci MN, Penbegul N, Atar M, Bozkurt Y, Soylemez H, Silay MS, Istanbulluoglu MO, Akman T, Armagan A (2013) Comparison of shockwave lithotripsy and microperc for treatment of kidney stones in children. J Endourol 27(9):1141–1146CrossRefPubMedGoogle Scholar
  23. 23.
    Salem HK, Fathy H, ElFayoumy H, Aly H, Ghonium A, Mohsen MA, Hegazy AE (2014) Slow vs rapid delivery rate shock wave lithotripsy for pediatric renal urolithiasis: a prospective randomized study. J Urol 191:1370–1374CrossRefPubMedGoogle Scholar
  24. 24.
    Jee JY, Kim SD, Cho WY (2013) Efficacy of extracorporeal shock wave lithotripsy in pediatric and adolescent urolithiasis. Korean J Urol 54:865–869CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Lei H, Sun X, Lu J, Cong X, Zhu H, Shen L, Wang Y (2011) Comparison of efficacy and safety of shockwave lithotripsy for upper urinary tract stones of different locations in children: a study of 311 cases. World J Urol 29:713–717CrossRefGoogle Scholar
  26. 26.
    Yucel S, Akin Y, Danisman A, Guntekin E (2012) Complications and associated factors of pediatric extracorporeal shock wave lithotripsy. J Urol 187(5):1812–1816CrossRefPubMedGoogle Scholar
  27. 27.
    El-Nahas AR, El-Assmy AM, Awad BA, Elhalwagy SM, Elshal AM, Sheir KZ (2013) Extracorporeal shockwave lithotripsy for renal stones in pediatric patients: a multivariate analysis model for estimating the stone-free probability. Int J Urol 20(12):1205–1210CrossRefPubMedGoogle Scholar
  28. 28.
    El-Assmy A, El-Nahas AR, Elsaadany MM, EL-Halwagy S, Sheir K (2015) Risk factors for formation of steinstrasse after extracorporeal shock wave lithotripsy for pediatric renal calculi: a multivariate analysis model. Int Urol Nephrol 47:573–577CrossRefPubMedGoogle Scholar
  29. 29.
    Kumar A, Kumar N, Vasudeva P, Kumar R, Jha SK, Singh H (2015) A single center experience comparing miniperc and Shock wave lithotripsy (SWL) for treatment of radioopaque 1–2 cm lower calyceal renal calculi in children: a prospective randomized study. J Endourol 29:805–809CrossRefPubMedGoogle Scholar
  30. 30.
    Onal B, Dogan HS, Satar N, Bilen CY, Güneş A, Ozden E (2014) Factors affecting complication rates of percutaneous nephrolithotomy in children: results of a multi-institutional retrospective analysis by the pediatric stone disease study group of the Turkish pediatric urology society. J Urol 191(3):777–782CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Ahmed Farouk
    • 1
  • Ahmed Tawfick
    • 1
    Email author
  • Mohamed Shoeb
    • 1
  • Mahmoud A. Mahmoud
    • 1
  • Diaa Eldin Mostafa
    • 1
  • Mohamed Hasan
    • 1
  • Hany M. Abdalla
    • 1
  1. 1.Department of UrologyAin Shams University HospitalCairoEgypt

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