Chatzikrachtis N. et al., 2023: Complication rate after pediatric shock wave lithotripsy according to Clavien-Dindo grading system: results from a systematic review and meta-analysis of the existing literature
Chatzikrachtis N, Tzelves L, Geraghty R, Manolitsis I, Juliebø-Jones P, Pietropaolo A, Karavitakis M, Berdempes M, Markopoulos T, Somani B, Skolarikos A.
2nd Department of Urology, National and Kapodistrian University of Athens, Sismanogleio Hospital, Athens, Greece.
Young Academic Urologists (YAU), Urolithiasis and Endourology Working Party, 6846, Arnhem, The Netherlands.
Department of Urology, The Newcastle upon Tyne Hospitals NHS Foundation, Newcastle upon Tyne, UK.
42nd Department of Urology, National and Kapodistrian University of Athens, Sismanogleio Hospital, Athens, Greece.
Department of Urology, Haukeland University Hospital, Bergen, Norway.
Department of Clinical Medicine, University of Bergen, Bergen, Norway.
Department of Urology, University Hospital Southampton NHS Trust, Southampton, SO16 6YD, UK.
Department of Urology, University General Hospital of Heraklion, University of Crete Medical School, Heraklion, Crete, Greece.
Purpose: Shockwave lithotripsy (SWL) is a minimally invasive technique utilized for renal and ureteric stones in children. Despite being considered safe, certain complications have been recorded. We performed this systematic review and meta-analysis to provide a pooled analysis of Clavien-Dindo graded complications after SWL in children.
Methods: MEDLINE/PubMed, Scopus and Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews, were screened from inception to 12/02/2022 by two authors independently. Only randomized controlled trials providing Clavien-Dindo classification or relevant clinical information were considered eligible. Overall complications were calculated using the aggregate number of each complication divided by the total number of patients in studies with data.
Results: Pooled analysis revealed that from children treated with SWL, 27.7% [95% CI 13.1-49.4] suffered Clavien I complications, 4.9% [95% CI 3.1-7.6] Clavien II complications, 2.7% [95% CI 1.6-4.7] Clavien III complications, 2.3% [95% CI 1.3-4] Clavien IV complications, while no Clavien V complications were recorded. In total, 28.1% [95% CI 15.6-45.3] of children suffered minor complications (Clavien-Dindo I-II), while 3% [95% CI 1.8-5] major complications (Clavien-Dindo III-V). Pooled analysis revealed that 10.7% [95% CI 3.2-30.1] of patients suffered macroscopic hematuria, 7.3% [95% CI 2.1-22.7] pain, 5.5% [95% CI 3.3-9] steinstrasse, 5.3% [95% CI 3-9.3] fever, 2.2% [95% CI 0.8-5.6] sepsis, 1.1% [95% CI 0.3-3.7] urinoma, 1% [95% CI 0.4-2.7] symptomatic hematoma and 1% [95% CI 0.3-2.7] asymptomatic hematoma. Need for re-treatment was 42.6% [95% CI 31.4-54.7] and need for auxiliary procedures was 11.8% [95% CI 8.5-16.1].
Conclusion: SWL is an irreplaceable tool for treating urolithiasis in children. Although a minimally invasive technique, parents and children should be adequately informed about the risk of minor/major complications.
World J Urol. 2023 Jan 4. doi: 10.1007/s00345-022-04267-x. Online ahead of print. PMID: 36598555.
Most meta-analyses only dig up what is already known, with little gain for the reader. This review offers valuable information to physicians informing parents and young patients about the risks of SWL.
By only including randomized controlled trials the results of some big cohort studies are missed, but the choice adds to the precision of data evaluated.
The authors have published a similar analysis of SWL in adults (1).
The series of 115 RCTs on 17.827 patients (1) does not include the 11 RCTs including 669 children cases of the present report (2) except 34 cases contained in both series (3). Thus, data are not overlapping and due to the identical selection and procession criteria comparable. They show a higher complication rate in children. In the adult series (1) the authors saw an inverse correlation between case volume and complication rate. This probably does not apply to the present study. Children series of SWL are usually small, however, they are usually part of a service with experience in adults and thus larger numbers.
1 Tzelves L, et al. Shockwave Lithotripsy Complications According to Modified Clavien-Dindo Grading System. A Systematic Review and Meta-regression Analysis in a Sample of 115 Randomized Controlled Trials. Eur Urol Focus. 2022 Sep;8(5):1452-1460. doi: 10.1016/j.euf.2021.11.002.
2 Chatzikrachtis N, et al. Complication rate after pediatric shock wave lithotripsy according to Clavien-Dindo grading system: results from a systematic review and meta-analysis of the existing literature.
World J Urol. 2023 Jan 4. doi: 10.1007/s00345-022-04267-x
3 Omran M, et al. Miniature semi-rigid ureteroscopy with holmium-yttrium-aluminium-garnet laser vs shockwave lithotripsy in the management of upper urinary tract stones >1 cm in children. Arab J Urol. 2020 Mar 23;18(2):106-111. doi: 10.1080/2090598X.2020.1738105.