Reviewer's Choice # Çitgez S. et al., 2026: Extracorporeal Shockwave Lithotripsy Still Alive for Pediatric Ureteral Stones ≤1.0 cm2. Peter Alken Thursday, 23 July 2026 25 Hits [ 0 Comments ](https://www.storzmedical.com/en/disciplines/literature-database-blog/database-lithotripsy/citgez-s-et-al-2026/?layout=listings#comments) Çitgez S, Kırlı EA, Demirbilek M, Irmak F, Dereköylü E, Önal B. J Endourol. 2026 Feb;40(2):252-259. [doi: 10.1177/08927790251372163](https://pubmed.ncbi.nlm.nih.gov/40899306/). Epub 2026 Feb 16. ## 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 They know what they are talking of and have a sound experience. Different from many other publications on stone treatment their individual attitude towards the different techniques becomes visible. At the same time, the choice of therapy was made on an individual, patient-specific basis: “Techniques and stone-free and complication rates of treatment options in the literature were shared with families and children ≥12 years old, considering their preferences.” and “Throughout the article, we emphasized that patient-related factors are the most critical determinants in selecting the optimal treatment to achieve stone-free status. In our study cohort, all patients met the guideline-based criteria for both treatment options. Therefore, families played an active role in the decision-making process.” This is particularly gratifying at a time when trends seem to dictate the choice of procedure. In this context, it seems to be appropriate to regard the stone-free rates of SWL (85% after the third session) and URS (80%) as comparable, or to classify a failure to pass the ureteroscope—necessitating the temporary placement of a double-J stent—as a failure of the URS procedure. Of course, this can also be viewed as a pre-existing and limiting assumption. Peter Alken 0 #### Comments No comments made yet. Be the first to submit a comment Thursday, 30 July 2026 I have read and agreed to the [Privacy Policy](https://www.storzmedical.com/javascript:void(0);)