Comparative Study between Retrograde Intrarenal Surgery, Mini-PCNL and Shock Wave Lithotripsy in Management of Pediatric Renal Stones

Objective: To compare safety, efficacy, and stone free rate of retrograde intrarenal surgery (RIRS), mini PCNL and extracoporeal shock wave lithotripsy (ESWL) in the treatment of pediatric renal stones.Patients and methods: Ninety pediatric patients (9-18 years old) with single renal stone (pelvis or lower calyx) 10-20 mm in size, were prospectively collected and randomly divided into three groups, A (RIRS), B (Mini-PCNL) and C (ESWL). RIRS was performed using flexible ureteroscope (Boston Scientific LithoVue™ 7.7/9.5Fr). Mini-PCNL was performed using rigid pediatric nephroscope (Storz miniperc 16.5 Fr) and the stones were fragmented or dusted in groups A and B using holmium:YAG laser (Luminis Pulse 30H). ESWL was performed using a piezoelectric lithotripter (Piezolith 3000 plus) device under fluoroscopy guidance. Results: Operative time significantly differed between the studied groups (P < 0.001), it was significantly higher in group B (101 ±11 min) than in groups A (82 ±9 min) and C (75 ±28 min). Fluoroscopy time significantly differed between the studied groups (P < 0.001), it was significantly higher in group B (103 ±14 sec) than in groups A (44 ±7 sec) and C (90 ±12 sec). The median hospital stay showed an overall significant difference between the studied groups (P < 0.001). No significant differences were observed regarding stone free rate (P = 0.667), pain score (P = 0.125), complications (P = 0.516), and complication type (P = 0.867).Conclusion: ESWL, RIRS and mini-PCNL are safe and effective methods in treatment of renal pediatric stones (10-20 mm).