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Nevertheless, the authors have made a valuable contributiony showing that it is possible to discharge most young childrenfter surgical procedures that would have been managed in mostenters with at least an overnight hospital stay. Careful attentiono pain control and prevention and/or management of nausea andomiting made it possible to discharge 85% of their patients. Theost common reason for admission in the 15% of children ob-

erved overnight was parental concern. With additional educa-ion of the parents before surgery, it is likely that the proportionf admissions would decrease. This paper leads one to wonderhether additional cost efficiencies are available by performingther renal operations on an outpatient basis.

REFERENCES1. McLorie GA, Pugach J, Pode D, et al: Safety and efficacy

f extracorporeal shock wave lithotripsy in infants. Can J Urol0: 2051–2055, 2003.2. Jackman SV, Hedican SP, Peters CA, et al: Percutaneous

ephrolithotomy in infants and preschool age children: expe-ience with a new technique. Urology 52: 697–701, 1998.

David A. Hatch, M.D.Department of Urology

Loyola University Medical Center

Chicago, Illinois

ROLOGY 64 (6), 2004

doi:10.1016/j.urology.2004.08.066© 2004 ELSEVIER INC.

ALL RIGHTS RESERVED

REPLY BY THE AUTHORSIn a country with a hot climate such as Egypt, stone

isease contributes to more than 30% of our pediatric urol-gy practice, and, as a specialized hospital, we treat annormous number of patients with stone disease. We be-ieve that there is a place for open surgery in those patientsho will require more than one session of extracorporeal

hock wave lithotripsy because of stone mass or who have aormal NONSIGNIFICANTLY dilated pelvicaliceal systemhat would be too valuable to injure even using the “mini-erc” technique. For other patients in our department, ex-racorporeal shock wave lithotripsy and the “mini-perc”echnique are used.

Mohamed Eissa, M.D.

doi:10.1016/j.urology.2004.08.067© 2004 ELSEVIER INC.

ALL RIGHTS RESERVED

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