Image not available

Freton L et al, 2016: Extracorporeal shockwave lithotripsy versus flexible ureteroscopy for the management of upper tract urinary stones in children.

Freton L, Peyronnet B, Arnaud A, Tondut L, Hascoët J, Pradere B, Verhoest G, Habonimana E, Azzis O, Fremond B, Bensalah K.
Department of Urology, CHU Rennes , Rennes, France.
Department of Pediatric Surgery, CHU Rennes , Rennes, France.

Abstract

OBJECTIVE: To compare the efficacy and morbidity of extracorporeal shockwave lithotripsy (ESWL) and flexible ureteroscopy (F-URS) for the management of upper urinary tract stones in children.
METHODS: All ESWL and F-URS performed in children in a single-institution between 2000 and 2014 were reviewed retrospectively. Only procedures performed to treat upper tract urinary stones (upper ureter or kidney) were included in this study. Preoperative and perioperative outcomes were compared between the ESWL and F-URS groups. Univariate and multivariate logistic regression analyses were used to evaluate predictors of stone free status (SF).
RESULTS: Over the study period 100 ESWL and 46 F-URS were conducted in 69 children. The ESWL and F-URS groups were comparable in terms of stone size (14.6 vs. 13.2 mm, p = 0.32) but there were more multiple stones (31% vs. 57%; p = 0.003) and lower pole calculi (14% vs. 37%; p = 0.003) in the F-URS group. The SF rate after one procedure was almost two times higher in the F-URS group compared to the ESWL group (37% vs. 21%; p = 0.04) without increasing the complication rate (21.7% vs. 16%; p = 0.31). Similar results were observed in the subgroup of single renal stones < 20 mm (SF rates: 78.6% vs. 50%; p=0.06). In multivariate analysis, the use of F-URS vs. ESWL was a predictor of a stone-free status (OR=3.7; p=0.02).
CONCLUSION: F-URS provides a higher single session SF rate despite more complex urinary stones (multiple, lower pole,....) and without increasing morbidity. 

J Endourol. 2016 Nov 8. [Epub ahead of print]

Rate this blog entry:
0
 

Comments 1

Peter Alken on Friday, 28 April 2017 09:03

The Storz Medical database contains a review on a paper by Wang HH et al. (Wang HH, Huang L, Routh JC, Nelson CP. Shock wave lithotripsy vs ureteroscopy: variation in surgical management of kidney stones at freestanding children's hospitals. J Urol. 2012 Apr;187(4):1402-7.) They had searched the US Pediatric Health Information System hospital database to identify children with renal calculi who were treated by ESWL or ureteroscopy between 2000 and 2008. Of 538 children 48% underwent ESWL and 52% ureteroscopy. They looked at hospitals which offered both treatment modalities. One would expect a similar application frequency of both techniques in the different hospitals. But a multivariate analysis showed the treating hospital was highly associated with procedure choice and the probability of SWL treatment ranged from 5% to 86% at different hospitals.
The present paper suggest that this is going to change and that - based on stone free and complications rates - URS in children will gain ground.
The primary endpoint was the stone free rate. The imaging modality, left at the surgeon’s discretion, did not differ between the ESWL and the URS group (KUB 85 % in the F-URS group and 88 % in the ESWL group; CT-scan 15.% in the F-URS group 12 % in the ESWL group.
The SFRs reported here have to be compared to recently reported data with CT determined SFRs after URS of only 59.2% despite “aggressive manual fragment extraction“ (WCE 2016 abstract MP37-9 Lay A, et al. Prospective evaluation of stone free rates by CT after aggressive ureteroscopy)
A bias cannot be excluded as the SFR was determined six weeks to three months after surgery and no data on the exact time in the two groups are reported.

The Storz Medical database contains a review on a paper by Wang HH et al. (Wang HH, Huang L, Routh JC, Nelson CP. Shock wave lithotripsy vs ureteroscopy: variation in surgical management of kidney stones at freestanding children's hospitals. J Urol. 2012 Apr;187(4):1402-7.) They had searched the US Pediatric Health Information System hospital database to identify children with renal calculi who were treated by ESWL or ureteroscopy between 2000 and 2008. Of 538 children 48% underwent ESWL and 52% ureteroscopy. They looked at hospitals which offered both treatment modalities. One would expect a similar application frequency of both techniques in the different hospitals. But a multivariate analysis showed the treating hospital was highly associated with procedure choice and the probability of SWL treatment ranged from 5% to 86% at different hospitals. The present paper suggest that this is going to change and that - based on stone free and complications rates - URS in children will gain ground. The primary endpoint was the stone free rate. The imaging modality, left at the surgeon’s discretion, did not differ between the ESWL and the URS group (KUB 85 % in the F-URS group and 88 % in the ESWL group; CT-scan 15.% in the F-URS group 12 % in the ESWL group. The SFRs reported here have to be compared to recently reported data with CT determined SFRs after URS of only 59.2% despite “aggressive manual fragment extraction“ (WCE 2016 abstract MP37-9 Lay A, et al. Prospective evaluation of stone free rates by CT after aggressive ureteroscopy) A bias cannot be excluded as the SFR was determined six weeks to three months after surgery and no data on the exact time in the two groups are reported.
Guest
Tuesday, 26 September 2017
STORZ MEDICAL AG
Lohstampfestrasse 8
8274 Tägerwilen
Switzerland
Tel.: +41 (0)71 677 45 45
Fax: +41 (0)71 677 45 05

www.storzmedical.com
Personal data
Address
Contact data
Message