Outcomes of Shock Wave Lithotripsy and Ureteroscopy for Treatment of Pediatric Urolithiasis

Abstract

Purpose: Shock wave lithotripsy has been commonly used to treat children with renal and ureteral calculi but recently ureteroscopy has been used more frequently. We examined postoperative outcomes from these 2 modalities in children. Materials and Methods: We reviewed linked inpatient, ambulatory surgery and emergency department data from 2007 to 2010 for 5 states to identify pediatric admissions for renal/ureteral calculi treated with shock wave lithotripsy or ureteroscopy. Unplanned readmissions, additional procedures and emergency room visits were extracted. Multivariate logistic regression using generalized estimating equations to adjust for hospital level clustering was performed. Results: We identified 2,281 admissions (1,087 for shock wave lithotripsy and 1,194 for ureteroscopy). Ages of patients undergoing ureteroscopy and those undergoing shock wave lithotripsy were similar (median 17.0 years for both cohorts, p = 0.001) but patients were more likely to be female (63.4% vs 54.7%, p <0.0001), to be privately insured (69.8% vs 62.2%, p <0.0005) and to have a ureteral stone (81.0% vs 34.8%, p <0.0001). Patients undergoing ureteroscopy demonstrated a lower rate of additional stone related procedures within 12 months (13.6% vs 18.8%, p <0.0007) but a higher rate of readmissions (10.8% vs 6.3%, p <0.0002) and emergency room visits (7.9% vs 4.9%, p <0.0036) within 30 days postoperatively. On multivariable analysis patients undergoing ureteroscopy were nearly twice as likely to visit an emergency room within 30 days of the procedure (OR 1.97, p <0.001) and to be readmitted to inpatient services (OR 1.71, p <0.01). Conclusions: Ureteroscopy is now used more commonly than shock wave lithotripsy for initial pediatric stone intervention. Although repeat treatment rates did not differ between procedures, ureteroscopy patients were more likely to be seen at an emergency room or hospitalized within 30 days of the initial procedure.

Interest of URS-L in the Treatment of Ureterolithiasis in Preschool Children

“…Effectiveness of ESWL compared to URS-L are reported around 70–80% vs. 86–100%, respectively (9). In our center URS-L was effective in 90% of the cases.…”

“…Results of our totally minimal invasive approach for stone treatment are comparable with the literature (10, 11). However, few publications studying this age group exist (9). During follow-up, we did not observe any complications, such as ureteral stricture formation or VUR appearance (12).…”

Ureteroscopy in Children-A Single Centre Study from a Developing Country

“…Pakistan is located in the geographic belt with high incidence of stone disease. [11,12] Alot of work has been done, in last 3 decades, regarding better and effective surgical management of urolithiasis [13]. Nowadays, approach for treatment of these stones has progressed from open surgical techniques to minimally invasive endourological management.…”

“…In USA, a recent trend of change has been observed regarding preference for the use of URS while treating ureter stones. According to their findings, it was noted that more children required additional sessions of SWL after initial shock wave lithotripsy.Keeping in view this phenomenon more children are likely to undergo URS as initial treatment modality for management of ureteric stones [13]. In modern countries URS has now become a safer procedure in pediatric population as well [17,18].…”

Laser access and utilization preferences for pediatric ureteroscopy: A survey of the Societies of Pediatric Urology

“…URS has been associated with a lower risk of subsequent retreatments than shock wave lithotripsy (SWL), although at the apparent cost of increased complications. 3,4 While there are limited data on comparative effectiveness for surgical management of UUTC in the pediatric population, this knowledge gap has been identified as an important area of future study by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). 5 As such, continued efforts to optimize surgical outcomes for pediatric UUTC must balance the treatment effectiveness against the operative morbidity.…”