Basiri A et al, 2010: A multicenter, randomized, controlled trial of transureteral and shock wave lithotripsy - which is the best minimally invasive modality to treat distal ureteral calculi in children?

Basiri A, Zare S, Tabibi A, Sharifiaghdas F, Aminsharifi A, Mousavi-Bahar SH, Ahmadnia H.
Urology and Nephrology Research Center (UNRC), Shahid Labbafinejad Medical Center, Shahid Beheshti University, M. C. (SBMU), Tehran, I. R. Iran.

Abstract

PURPOSE: Since there is insufficient evidence to determine the best treatment modality in children with distal ureteral calculi, we designed a multicenter, randomized, controlled trial to evaluate the efficacy and complications of transureteral and shock wave lithotripsy in these patients.

MATERIALS AND METHODS: A total of 100 children with distal ureteral calculi were included in the study. Of the patients 50 were randomized consecutively to undergo shock wave lithotripsy using a Compact Delta II lithotriptor (Dornier MedTech, Kennesaw, Georgia), and 50 were randomized to undergo transureteral lithotripsy with holmium laser and pneumatic lithotriptor between February 2007 and October 2009. Stone-free, complication and efficiency quotient rates were assessed in each group.

RESULTS: Mean +/- SD patient age was 6.5 +/- 3.7 years (range 1 to 13). Mean stone surface was 35 mm(2) in the transureteral group and 37 mm(2) in the shock wave lithotripsy group. Stone-free rates at 2 weeks after transureteral lithotripsy and single session shock wave lithotripsy differed significantly, at 78% and 56%, respectively (p = 0.004). With 2 sessions of shock wave lithotripsy the stone-free rate increased to 72%. Efficiency quotient was significantly higher for transureteral vs shock wave lithotripsy (81% vs 62%, p = 0.001). Minor complications were comparable and negligible between the groups. Two patients (4%) who underwent transureteral lithotripsy sustained a ureteral perforation.

CONCLUSIONS: In the short term it seems that transureteral and shock wave lithotripsy are acceptable modalities for the treatment of distal ureteral calculi in children. However, transureteral lithotripsy has a higher efficacy rate when performed meticulously by experienced hands using appropriate instruments.

2010 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

J Urol. 2010 Sep;184(3):1106-9. doi: 10.1016/j.juro.2010.05.021. Epub 2010 Jul 21
PMID: 20650490 [PubMed - indexed for MEDLINE]