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

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

Background

Prior research has assessed a range of surgical treatments for pediatric urolithiasis, emphasizing the necessity of tailor-made therapeutic approaches. These studies also show the adaptability of percutaneous nephrolithotomy (PCNL), retrograde intrarenal surgery (RIRS), and shock wave lithotripsy (SWL) in managing diverse stone dimensions. The goal of this research was to examine the effectiveness of these varying surgical methods in treating pediatric urolithiasis.

Methods

Seven digital databases were explored to gather pertinent studies, following the guidelines established by the PRISMA protocol. The retrieved studies were subsequently scrutinized to draw comparisons between the stone-free rate (SFR) and the rate of complications associated with PCNL, RIRS, and SWL.

Results

The SFR evaluation revealed no notable disparity between PCNL and RIRS [odds ratio (OR) 1.43, 95% confidence interval (CI): 0.67-3.05, P=0.36]. However, it was observed that both PCNL and RIRS outperformed SWL in terms of effectiveness (OR 2.51, 95% CI: 1.19-5.29, P=0.02 and OR 2.42, 95% CI: 1.41-4.14, P=0.001 respectively). Regarding the complication rates, no significant differences were observed among the three surgical methods (OR 0.67, 95% CI: 0.49-1.59, P=0.05), albeit with various forms of complications being reported. Certain studies associated PCNL with an elevated rate of complications, specifically urinary tract infections (UTIs) and severe hematuria.

Conclusions

Though PCNL and RIRS demonstrated higher effectiveness than SWL in achieving SFR, there was no significant disparity in the rates of complications across all three procedures. The study underscores the significance of personalized treatment plans, taking into account aspects such as the dimension and location of the stone, along with patient-specific characteristics.

Is flexible ureteroscopy and laser lithotripsy (FURSL) the new gold standard for paediatric lower pole stones: Outcomes from 2 large European tertiary paediatric endourology centres

INTRODUCTION

While paediatric ureteroscopy has been increasingly performed, the evidence for its use in paediatric lower pole stones (LPS) is sparce. In this study we look at the effectiveness and outcomes of flexible ureteroscopy and lasertripsy (FURSL) in the management of LPS for a paediatric population.

METHODS

Data were collected from two large European tertiary endourology centres which specialise in paediatric kidney stone management. The study was registered as an audit at the respective hospitals. All data were cross-checked and analysed using electronic operative notes, discharge records, laboratory systems and patient correspondence. The inclusion criteria were patients 16 years with lower pole stones having a FURSL procedure.

RESULTS

A total of 57 paediatric patients underwent FURSL for LPS. The mean age was 10.1 years + 4.7 (range: 1-16.9 years) with a male:female ratio of 2:3. The mean single stone size was 9.45+3.9 mm (range: 3-20 mm) and 31(54.4%) had multiple stones. A pre-operative stent was present in 18(31.6%) patients and a post-operative stent or ureteric catheter was left behind in 32(56.1%) patients. The initial and final SFR was 82.4% and 98.2% respectively with 1.19 procedures per patient performed to be stone free. While there were no intra-operative complications, there were only four(7%) minor complications (Clavien I) noted which were all simple urinary infections. No long-term complications were noted.

CONCLUSION

Flexible ureteroscopy and lasertripsy achieves excellent outcomes for treatment of paediatric LPS. While some patients might need a second procedure for complete stone clearance, FURSL may be considered as the first-line treatment of lower pole stones.