Çitgez S. et al., 2025: Extracorporeal Shockwave Lithotripsy Still Alive for Pediatric Ureteral Stones ≤1.0 cm2.

Sinharib Çitgez, Elif Altınay Kırlı, Muhammet Demirbilek, Feyyaz Irmak, Engin Dereköylü, Bülent Önal 
Ureteral Stones ≤1.0 cm2. J Endourol. 2025 Sep 3. doi: 10.1177/08927790251372163. 

Abstract

Introduction: This retrospective study compares extracorporeal shockwave lithotripsy (SWL) and ureteroscopy (URS) in pediatric ureteral stones ≤1.0 cm2, aiming to determine the optimal treatment based on clinical outcomes. Patients and Methods: The study included patients with ureteral stones ≤1.0 cm2 eligible for SWL or URS. Treatment choices were made based on family decisions. SWL was performed under sedation, with 180° rotation for distal stones, whereas URS was conducted under general anesthesia using semirigid/flexible ureteroscopes with Ho:YAG laser lithotripsy. Complications were classified using Satava and Clavien criteria, respectively. Results: A total of 230 children (median age:7 y/o, interquartile range 4-12) underwent SWL (n = 129, 56%) or URS (n = 101, 44%)for ureteral stones ≤1.0 cm2. The groups were comparable in terms of demographic characteristics. SWL and URS had comparable stone-free rates (85% vs 80, p = 0.276), and there was no difference according to the location. However, URS had a higher overall complication rate (16% vs 4%, p = 0.005). Complication rates were significantly higher for distal stones treated with URS (p = 0.009), whereas stone-free rates were similar between proximal (p = 0.821) and distal stones (p = 0.332). Logistic regression analysis revealed that female gender and stone burden were significant factors in achieving overall stone-free status. When stone-free outcomes were evaluated based on stone location, female gender and a history of previous minimally invasive stone intervention were also found to be influential predictors. Conclusion: These findings indicate that SWL and URS provide comparable efficacy in stone clearance, but URS is associated with a higher complication rate, particularly for distal ureteral stones. Additionally, our data suggest that SWL remains a preferable first-line option, particularly for stones ≤1.0 cm2, whereas URS might be reserved for cases with larger stone burdens or prior treatment failures.

Comment Peter Alken

May be the authors were a little bit unfair to URS: “If dilation failed, safe ureteral access and sheath placement could not be achieved, or pyuria drainage from the upper tract was observed, a Double-J stent was placed, and URS was postponed. These cases were classifiedas failed procedures”
compared with up to three sessions SWL
“Stone-free status was achieved after the first SWL session in 58% of patients (n = 75), after the second session in 20% (n = 26), and after the third session in 7% (n = 8). The overall success rate of SWL was 85% (n = 110)”.
However on the other hand, I wonder how unhappy children and parents were with the stent related symptoms during 4 weeks and another general anesthesia : ”Double-J stent was placed in all children. The stent was removed under general anesthesia after 1 month.”

Peter Alken