Comparison of extracorporeal shockwave lithotripsy and retrograde intrarenal surgery in the treatment of renal pelvic and proximal ureteral stones ≤2 cm in children

Abstract

Introduction: We aimed to compare extracorporeal shockwave lithotripsy (ESWL) and retrograde intrarenal surgery (RIRS) in pediatric patients with ≤2 cm renal pelvis and proximal ureteral stones. Methods: Medical records of 165 pediatric patients who underwent shockwave lithotripsy (SWL) or RIRS for upper urinary system stones up to 2 cm between January 2014 and December 2018 were retrospectively reviewed. After exclusions, the remaining 130 patients included 73 in the SWL group and 57 in the RIRS group. The groups were compared for demographic features, stone characteristics, operative data, success, and complications. Results: The mean stone volume was 308 ± 85 (54–800) and 336 ± 96 (60–720) mm 3 in SWL and RIRS groups, respectively ( P = 0.46). There were no significant differences in success rates (60% vs. 70%, SWL and RIRS), auxiliary treatment rates (16.4% vs. 14%), and complication rates (26% vs. 24.5%). The number of active procedural sessions and number of anesthesia sessions was higher in the RIRS group ( P < 0.001 and P < 0.001, respectively), while the procedural time and anesthesia time were higher in the SWL group ( P < 0.001 and P < 0.001, respectively). Stone size was found to be an independent success predictive factor for both the treatment modalities. Conclusions: Both SWL and RIRS have similar success, complication, and auxiliary treatment rates. RIRS was superior in terms of total procedure and anesthesia durations, while SWL was superior in terms of numbers of anesthesia sessions and active procedure sessions. As both have similar success rates, the more minimally invasive SWL should be chosen for pediatric upper urinary system stones of less than 2 cm size.

Comparative efficacy of different surgical techniques for pediatric urolithiasis—a systematic review and meta-analysis

“…The study sample sizes ranged from as low as 43 AME ( 19 ) to as high as 212 AME ( 17 ). These samples were drawn from diverse regions, including Turkey ( 20 , 24 , 26 - 28 ), Italy ( 21 ), Egypt ( 18 , 19 , 22 ), France ( 23 ), Poland ( 25 ), India ( 17 ), and China ( 29 ). The mean age of the participants varied significantly across the studies.…”

“…The youngest mean age was reported to be 2.4±1.3 years ( 18 ). Some studies reported mean ages for different groups, showing variability within their samples ( 19 , 20 , 22 - 24 , 26 - 28 ). Gender distribution, where specified, was skewed towards males in all studies ( 17 - 22 , 24 - 27 , 29 ).…”

“…Some studies reported mean ages for different groups, showing variability within their samples ( 19 , 20 , 22 - 24 , 26 - 28 ). Gender distribution, where specified, was skewed towards males in all studies ( 17 - 22 , 24 - 27 , 29 ). However, one study did not specify the gender ratio ( 23 ).…”

“…They ranged from short periods such as 0.25 years ( 18 , 29 ) to extended periods like 33.14±6.07 years ( 22 ). However, several studies did not specify the follow-up period ( 19 , 23 , 24 , 27 ).…”

Re: Guler Y, Erbin A. Comparison of extracorporeal shockwave lithotripsy and retrograde intrarenal surgery in the treatment of renal pelvic and proximal ureteral stones ≤2 cm in children. Indian J Urol 2020;36:282-7

“…We read the article by Guler et al . [ 1 ] with interest and appreciate the authors for providing insight toward the role of extracorporeal shockwaves lithotripsy (ESWL) and retrograde intrarenal surgery (RIRS) in pediatric urolithiasis through a comparative trial. However, we have the following observations.…”