Extracorporeal shock wave lithotripsy (ESWL) versus flexible ureteroscopy (F-URS) for management of renal stone burden less than 2 cm in children: A randomized comparative study

Abstract

Objective: To compare the outcome of flexible ureteroscopy (F-URS) versus extracorporeal shock wave lithotripsy (ESWL) for the management of renal stone burden less than 2 cm in children.

Patients and methods: A randomized comparative study was conducted at our hospital between December 2013 and May 2015. Seventy two children with renal stone burden less than 2 cm were assessed for eligibility. Our primary outcome is to assess the stone free rate after the first session. The secondary goal is to assess the operative outcome and the associated postoperative complications.

Results: Finally, 57 children were completed the treatment and follow up; 27 patients in F-URS group and 30 patients in ESWL group. Patient’s demographics and stone characteristics were comparable between both groups. F-URS group was associated with significantly longer operative time and hospital stay versus ESWL group. Overall complications occurred in 29.6% and 33.3% in F-URS groups and ESWL group, respectively (p value = 0.1) and most of them were of minor degree. F-URS was associated with significantly higher stone free rate after the first session which reached 81.4% versus 53.3% for ESWL group (p value = 0.00). The overall success was 92.5% and 90% in F-URS and ESWL group, respectively (p value = 0.5).

Conclusion: Stone free rate after one session of F-URS is higher than ESWL with comparable rates of complications. F-URS could be offered to children who are less likely to respond completely after ESWL monotherapy.

Keywords: Pediatric urolithiasis; Minimal invasive stone management; Flexible URS; ESWL