Vol.:(0123456789) 1 3 World Journal of Urology https://doi.org/10.1007/s00345-018-2231-9 ORIGINAL ARTICLE Is mini‑percutaneous nephrolithotomy a safe alternative to extracorporeal shockwave lithotripsy in pediatric age group in borderline stones? a randomized prospective study Ahmed Farouk 1  · Ahmed Tawfck 1  · Mohamed Shoeb 1  · Mahmoud A. Mahmoud 1  · Diaa Eldin Mostafa 1  · Mohamed Hasan 1  · Hany M. Abdalla 1 Received: 22 August 2017 / Accepted: 7 February 2018 © Springer-Verlag GmbH Germany, part of Springer Nature 2018 Abstract Purpose The extracorporeal shockwave lithotripsy (ESWL) remains the most common frst 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. Results The stone-free rate (SFR) after frst session was 88.9% (48 cases) and 55.6% (30 cases) for groups A and B, respec- tively. The diference is highly statistically signifcant 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 insignifcant. The mean hospital stay and fuoroscopy exposure were signifcantly 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 insignifcant (P = 0.484). Conclusions 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. Keywords Mini-percutaneous nephrolithotomy · ESWL · Extracorporeal shock wave lithotrips · Pediatric renal stone · Endourology Abbreviations PCNL Percutaneous nephrolithotomy ESWL Extracorporeal shockwave lithotripsy YAG Neodymium-doped yttrium aluminium garnet CIRF Clinically insignifcant residual fragments KUB Kidneys, ureters and bladder US Ultrasonography SFR Stone-free rate Introduction The incidence of pediatric renal stones has increased at an annual rate of about 6–10% and is currently 50 per 100,000 [1]. Such stones can be managed either by extracorporeal shockwave lithotripsy (ESWL), retrograde intrarenal surgery (RIRS), percutaneous nephrolithotomy (PCNL), or open, laparoscopic and robotic surgery [2]. ESWL is the frst line of treatment for pediatric renal stones because it carries the advantages of a shorter hospital stay, rapid recovery, minimal morbidity, acceptable success rates and generally has a high safety profle [3]. Addition- ally, the anatomic characteristics of the infant body such as the small size and increased peristalsis and fexibility of the child’s ureter make ESWL the main and favored type of treatment [4]. * Ahmed Tawfck murmer_urology26@hotmail.com 1 Department of Urology, Ain Shams University Hospital, Cairo, Egypt