Abdel-Kader MS. et al., 2023: Which is better, fluoroscopic-guided or ultrasonic-guided shock wave lithotripsy for pediatric renal stones? Prospective randomized comparative study
Abdel-Kader MS, Fathy A, Moubarek M, Abolyosr A.
Department of Urology, South Valley University, Qena, Egypt.
Department of Urology, South Valley University, Qena, Egypt.
Abstract
Objectives: To compare the efficacy and clinical outcomes of two different stone localization modalities (fluoroscopic or ultrasonic) in SWL treatment of pediatric renal stones.
Patients and methods: This study was conducted in the period between January 2021 and June 2022 and included 100 children aged 2-16 years who presented with radio-opaque renal pelvic stones < 20 mm. The children were divided in two groups: group I, US-guided (50 patients), and group II, FS-guided SWL (50 patients). SWL was applied under general anesthesia. The follow-up of the patients included a visit every two weeks up to three months.
Results: Even though group II's stone-free rate after one month of follow-up was higher than group I's (90% vs. 84%), no statistically significant difference was found between the groups (p = 0.749). While the success rate was higher in group II than in group I (92% vs. 86%), no statistically significant difference was observed between the two groups (p = 0.338). The complication rate was 28% (14 patients) and 12% (6 patients) in Groups I and II, respectively. However, no significant difference was found between the two groups (p = 0.132).
Conclusions: SWL is a non-invasive and safe method for treating pediatric renal stones. We recommend the use of the ultrasonic focusing modality in SWL of the pediatric age group, which has similar success rates, avoiding radiation and low complication rate instead of the fluoroscopic focusing modality, which uses ionizing radiation during SWL.
World J Urol. 2023 Feb 7. doi: 10.1007/s00345-023-04313-2. Online ahead of print. PMID: 36746808
Comments 1
There is no doubt that US-guided SWL is advantageous in comparison with fluoroscopy by avoiding the danger of radiation. This is particularly important for children. But generally, it is attractive to apply radiation-free SWL in all patients.
In the current report the authors carried out a randomized prospective comparison between US and fluoroscopy and concluded that there were no significant differences in terms of stone-free rates or successful treatment between the two methods. The authors used a Dornier Gemini lithotripter with fully integrated fluoroscopy and US guidance systems.
Nothing is mentioned about the fact that US is highly operator dependent, and that fluoroscopy has been easier to use by urologists in general. Nevertheless, the outcome of US-guided SWL treated patients was surprisingly good. The major problem with the study is the small number of patients, but it stands to reason that when US can be used, it should be used. One important requirement is, however, that an integrated user-friendly US system is available for the lithotripter. It can be recommended for future use of SWL that US is increasingly applied to reduce radiation.
Hans-Göran Tiselius