Flexible Ureteroscopy May Beat ESWL for Pediatric Stone Patients
Flexible ureteroscopy achieved a stone-free rate nearly twice as high as that achieved with extracorporeal shock wave lithotripsy.
NEW ORLEANS—Flexible ureteroscopy (F-URS) may be associated with better outcomes than extracorporeal shock wave lithotripsy (ESWL) for managing upper tract urinary stones in children, researchers reported at the 2015 American Urological Association annual meeting.
Benoit Peyronnet, MD, and colleagues at the University of Rennes in Rennes, France, studied 100 ESWL and 46 F-URS procedures conducted in 69 children. The ESWL and F-URS groups were similar with respect to stone size (14.6 and 13.2 mm, respectively), but the F-URS group had significantly more patients with multiple stones (57% vs. 31%) and lower pole calculi (37% vs. 14%). The stone-free rate after 1 procedure was significantly higher in the F-URS than ESWL group (37% vs. 21%). The 2 groups had similar complication rates, but significantly more patients in the F-URS group required general anesthesia (100% vs. 81%). F-URS patients also had a significantly longer length of stay (1.4 vs. 0.9 days).
Current guidelines recommend ESWL as first-line treatment of kidney stones smaller than 2 cm in children. No previous study has compared outcomes of ESWL and F-URS in the treatment of upper tract urinary stones in children, according to the investigators.