Abstract: PD30-02
Sources of Funding: none

Introduction

To compare the safety and outcome of FURS and shock wave lithotripsy (SWL) for treatment of (1-2) cm renal stones in children with a solitary kidney.

Methods

Between April 2011 and April 2016, all children (< 15 years) with a renal stones (1-2) cm in a solitary kidney were randomized into two groups – group 1, FURS ; group 2 SWL. In FURS group , A 7.5 Fr flexible ureteroscope (FURS) was introduced into the ureter over a hydrophilic guidewire under visual and fluoroscopic guidance without access sheath . Complete stone dusting using 200 ?m laser fiber (0.2– 1.0 joules power and15–30 Hz frequency) was done in all cases ended with a 5 Fr JJ stent insertion. The children were discharged home 4 hours postoperative in absence of the complications. Both groups were compared as regard the stone hardness, size, the complications (intraoperative and postoperative), the number of anaesthesia sessions and the need for auxiliary procedure.

Results

11 cases with median age (9.3 years vs 9.6 years, P = 0.55) were enrolled in each group. The stone size was (11+_ 4 mm vs 13 _+ 3 mm, P = 0.30), the stone hardness (785 +_ 85 HU vs 800 _+ 75 HU, P= 0.36) were comparable between the two groups. All cases of SWL group need preoperative DJ stent (3 for their obstructive anuria while the remaining to avoid post SWL obstructive anuria) while DJ stent were inserted in 2 cases of FURS group because of their presentation as an obstructive anuria and one case intraoperative for passive ureteral dilation of a tight ureter that not allow introduction of the FURS. 6 cases in SWL group need a second session of SWL vs one in FURS group with passive ureteral dilation (P = 0.001). The stone free rate after 1 month was 95 % in SWL group including the second sessions vs 96% in FURS group (P = 0.04). 4 cases of SWL group needs URS and another DJ stent after its removal because of obstructive anuria by stone fragments vs only one case in FURS group (P = 0.001). Intraoperative complication in the form mucosal perforation was reported in one case of FURS group while no intraoperative complication was recorded in SWL group. The hospital stay was comparable in both groups (4+_ 1 hours in SWL group vs 4 h+_ 1.5 hours in FURS group )(P = 0.30). The anaesthetic sessions (including stent removal) were 47 sessions in SWL group vs 24 sessions in FURS group (P = 0.001).

Conclusions

FURS and SWL are comparable as regard the stone free rate in paediatric renal stone (1-2) cm with a solitary kidney. FUR carries the advantage of single session procedure, less need to postoperative auxiliary procedure with resultant less anaesthetic sessions. SWL carries the advantages of low intraoperative complications.

Funding

none