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Chua ME. et al., 2022: Scoping review of recent evidence on the management of pediatric urolithiasis: summary of meta-analyses, systematic reviews and relevant randomized controlled trials.

Chua ME, Kim JK, Ming JM, De Cotiis KN, Yang SS, Rickard M, Lorenzo AJ, Dos Santos J.
Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada.
Department of Surgery, University of Toronto, Toronto, ON, Canada.
Institute of Urology, St. Luke's Medical Center, Quezon City, Philippines.
Department of Surgery, University of Toronto, Toronto, ON, Canada.
Department of Urology, University of New Mexico, Albuquerque, NM, USA.
Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada.
Department of Urology, Thomas Jefferson University, Philadelphia, PA, USA.
8Division of Urology, Buddhist Tzu Chi General Hospital, New Taipei Branch, New Taipei City, Taiwan.

Abstract

This scoping review aimed to evaluate and summarize the recent 10 year pediatric urolithiasis literature with a particular focus on systematic reviews, randomized-controlled trials (RCT) and meta-analysis. The systematic literature search performed on September 1, 2021, restricted to the recent 10 years, focused on pediatric urolithiasis that are RCTs, meta-analysis and systematic reviews. The summarized literature included etiology, diagnostics, medical and surgical management. GRADE criteria are used to evaluate and standardize the reporting of evidence quality. A total of 33 relevant articles were included. The recent high-level studies included topics of genetic and diet association with pediatric stone formation, diagnostic assessment, medical management intervention including medical dissolution and expulsion therapy. The study extended to include the efficacy and safety of extracorporeal lithotripsy, percutaneous nephrolithotomy and retrograde intrarenal surgery. However, evidence quality was ranked "very-low" or "low". Based on the GRADE criteria downgrading of the quality level was due to heterogeneity and low precision. A majority of the RCTs were categorized as having a "high" to "uncertain" risk of bias. The relevant RCTs, meta-analyses and systematic reviews within the past decade are of low quality. Consequently, the research provided no clear evidence-based recommendations for managing pediatric urolithiasis. More rigorous research and high-quality studies are needed to determine the best practices.
Pediatr Surg Int. 2022 Oct;38(10):1349-1361. doi: 10.1007/s00383-022-05190-3. Epub 2022 Aug 8. PMID: 35939126 Review.

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Comments 1

Hans-Göran Tiselius on Saturday, 24 December 2022 09:30

This review of recent scientific data on the management of pediatric urolithiasis covers several different aspects of which surgical stone removal only is one.

In terms of SWL the important conclusion was that result of proximal ureteral stones was better than that for mid/distal stones. Of note from a cited Cochran study is that SWL of renal stones was more reliable than URS irrespective of type of disintegration.

The value of artificial hydronephrosis is mentioned, but my own reflection is that administration of saline via a ureteral catheter during the treatment might increase the risk of infection complications.

Like in many studies comparison of shockwave frequencies 80 and 120 showed, as expected, a higher stone-free rate with the low frequency.
One point that deserves attention is that although stone-free rate and efficiency quotients were superior following PCNL, the fluoroscopy times were shorter for both SWL and RIRS. That SWL had lower EQ compared with PCNL and RIRS was, however, not surprising.

Of note: there were 2 ureteral perforations in 50 URS.

One interesting basic observation from this extensive review was that most studies had “very low” or “low” quality and the authors’ conclusion was that: “Unfortunately the current literature lacks definite recommendations for surgical management”

Hans-Göran Tiselius

This review of recent scientific data on the management of pediatric urolithiasis covers several different aspects of which surgical stone removal only is one. In terms of SWL the important conclusion was that result of proximal ureteral stones was better than that for mid/distal stones. Of note from a cited Cochran study is that SWL of renal stones was more reliable than URS irrespective of type of disintegration. The value of artificial hydronephrosis is mentioned, but my own reflection is that administration of saline via a ureteral catheter during the treatment might increase the risk of infection complications. Like in many studies comparison of shockwave frequencies 80 and 120 showed, as expected, a higher stone-free rate with the low frequency. One point that deserves attention is that although stone-free rate and efficiency quotients were superior following PCNL, the fluoroscopy times were shorter for both SWL and RIRS. That SWL had lower EQ compared with PCNL and RIRS was, however, not surprising. Of note: there were 2 ureteral perforations in 50 URS. One interesting basic observation from this extensive review was that most studies had “very low” or “low” quality and the authors’ conclusion was that: “Unfortunately the current literature lacks definite recommendations for surgical management” Hans-Göran Tiselius
Monday, 20 May 2024