Shock wave lithotripsy (SWL) and ureteroscopy (URS) offer similar stone clearance rates in children, but SWL is associated with less morbidity, new data suggest.
In a study comparing 84 SWL and 175 URS procedures performed from 2000 to 2017, Kathryn A. Marchetti, MD, of the University of Michigan in Ann Arbor, and colleagues found no significant difference between the procedures in the rates of complete stone clearance and residual stone fragments less than 4 mm (77% and 90.8%, respectively, after the final SWL procedure and 78.5% and 91.7%, respectively, for URS).
Retreatment rates for both procedures also did not differ significantly (17.9% for SWL vs 18.9% for URS), Dr Marchetti’s team reported in the Journal of Pediatric Urology.
SWL, however, was associated with less morbidity than URS. Children who underwent SWL had lower rates of emergency room visits for urinary tract infection (0% vs 5.1%) and flank pain (3.6% vs. 10.9%). SWL recipients also required fewer general anesthetics per treatment (1.2 vs 2.0), according to the investigators.
The investigators explained that children present unique challenges to surgical management, including smaller patient size, limited ability to tolerate bedside procedures, and increased risks associated with radiation and anesthetic exposure. Consequently, current comparative effectiveness studies in adults cannot be extrapolated early to pediatric patients, they noted. “Furthermore, much of the recent literature in children does not look beyond stone clearance to evaluate the varying morbidity of SWL and URS, such as exposure to general anesthesia, use of ureteral stents, and postoperative complications.”
Dr Marchetti and her team acknowledged that the retrospective nature of the study was a limitation. In addition, variability in surgeon experience and technique likely impacted treatment efficacy, specifically with URS, they noted. Another limitation was the collection of data over a nearly 20-year span during which instrumentation and surgical technique evolved.
Marchetti KA, Lee T, Raja N, et al. Extracorporeal shock wave lithotripsy versus ureteroscopy for management of pediatric nephrolithiasis in upper urinary tract stones: multi-institutional outcomes of efficacy and morbidity. J Pediat Urol. 2019; doi: 10.1016/j.jpurol.2019.06.006