الفهرس 
ANATOMYOnly 14 pages are availabe for public view
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Abstract
Background: The prevalence of urinary stone disease under the age of 18 is nearly 1-2%. The treatment of calyceal stones presents a conflict for the urologists. With improvements in fiber optic designs, downsizing of instrumentations, better irrigation system ,and the availability of small instruments, both powered and mechanical to allow complex maneuvers within the confines of the upper urinary tract.
Aim of the Study: This work aims to compare the clinical outcome of Retrograde Intra Renal Surgery (RIRS) using laser lithotripsy and Mini percutaneous nephrolithotomy (Mini- PCNL) in the management of pediatric kidney stones regarding stone clearance rate, the time factor, Hospitalization, and complications.
Methodology: This is a prospective randomized double-armed controlled clinical study, carried out Between January 2019 and January 2022, including 90 pediatric patients, presented to the Urology Department, Ain Shams University Hospitals. Our study was assigned on a randomized basis according to a 1:1 ratio and pediatric patients underwent either RIRS or mini PCNL randomly. pediatric Patients included in our study were randomly allocated into one of two groups by sealed envelope and were blinded to the surgical technique.
Results: Overall, the stone clearance rate was not significant but lower for RIRS (88.9%) than mini-PCNL(95.6%). For the acceptability of a procedure, its technical feasibility was essential, which may be a limitation with RIRS that was the longer operative time. This can be attributed to the placement of the ureteral access sheath before the procedure and the time-consuming maneuver required in RIRS for stone fragmentation, i.e., placement of stones in an appropriate calyx to avoid strain on the deflection mechanism and the risk of laser fiber damaging the scope. One of the objectives of this study was to estimate the advantages and efficacy of both the procedures. Both the techniques were equally safe because there was no significant difference in complication rates between both the groups.
Conclusion: This study demonstrated that both modalities give high stone clearance rates with minimal complications, in the selected group of patients having only calyceal and pelvic stones equal to or less than 30 mm. RIRS is also safe and can be used as a standard treatment modality for small and moderate burden renal calculi.