AbdelRazek M et al, 2018: SWL outcome in artificial hydronephrotic vs. non-hydronephrotic kidney for preschool children with high-density renal stones.
AbdelRazek M, Hassan A, AbdelKader MS, Abolyosr A.
Department of Urology, Qena University Hospital, South Valley University, Qena, Egypt.
Abstract
OBJECTIVE: To assess the effect of artificial hydronephrosis on the result of shock wave lithotripsy (SWL) in preschool children.
MATERIALS AND METHODS: A prospective randomized trial was performed between January 2013 and January 2017 with 300 pediatric patients, having kidney stones with a size of 1-2 cm and a density of 750-1100 HU. The patients were randomized into two groups: group A, in which a ureteric catheter was fixed and artificial hydronephrosis was performed by fluid irrigation prior to SWL, and group B which did not undergo hydronephrosis. SWL outcomes were compared between two groups.
RESULTS: In total, 153 cases were assigned to group A, and 147 cases were assigned to group B. Regarding demographic data, there was no statistically significant difference between the two groups. There were also no statistically significant differences in the number of shocks and energy power needed for each group. The results of SWL after the first session favored group A with a stone-free rate (SFR) of 90.8% vs. 75.5% for group B. The SFR after SWL was significantly in favor of group A (94.1%) vs. (86.4%) for group B.
CONCLUSION: The use of an artificial hydronephrosis technique to make interface around the stone improves stone-free rate and decreases the need for retreatment after SWL.
World J Urol. 2018 Aug 30. doi: 10.1007/s00345-018-2471-8. [Epub ahead of print]
Comments 1
One observation from the early days of SWL was that with a layer of fluid around the stone, disintegration was improved.
In this highly interesting report of SWL in pediatric patients the authors randomized their patients to two groups. Children in Group A were treated with SWL during fluid irrigation via a ureteral catheter with the aim of creating a fluid space around the stone. Group B was treated in the standard way without fluid irrigation.
Interestingly the stone-free rates after one SWL session were roughly 91 and 76 % in groups A and B, respectively. After 3 months the corresponding stone-free-rates were 94 and 86%. Highly interesting and of great clinical importance was the observation that 84 and 64% of children treated for stones in the lower calyces in groups A and B were stone-free after 3 months. This latter result was achieved despite retreatment rates of 20 and 68 %!!
Retrograde irrigation significantly improved the outcome and the result gives support to previous observations on the value of fluid around stones during disintegration. The described method seems to be of great clinical value but there might also be place for a little note of caution by avoiding too vigorous irrigation in the presence of bacteriuria or infection stones, to avoid the risk of septic complications.
My personal experience in children as well as in adults has been to carry out SWL during forced diuresis with fluid infusion and furosemide. It would be interesting to compare the effects of retrograde irrigation with ureteral catheter and high diuresis. Both techniques have the aim of creating a fluid space around the stone.
There were no ureteral stones included in the present report but when we, some years ago, compared treatment of ureteral stones with or without ureteral catheter, no difference was recorded between our two groups. Also, this method had the aim to study the effect of a fluid space around the stones.