Kırlı EA. et al., 2020: Does Previous Open Stone Surgery Affect the Outcome of Shock Wave Lithotripsy Treatment in Children?
Kırlı EA, Türegün FA, Selçuk B, Gültekin MH, Tansu N, Erözenci A, Önal B.
Does Previous Open Stone Surgery Affect the Outcome of Shock Wave Lithotripsy Treatment in Children?
Introduction: The aim of the study was to evaluate the efficiency of shock wave lithotripsy (SWL) in children who previously underwent ipsilateral open renal stone surgery (ORSS).
Methods: A total of 315 renal units (RUs) with renal stones underwent SWL treatment in our department over a period of 18 years. A total of 274 RUs (87%) with no history of ORSS were categorized as group 1 and 41 RUs (13%) with a history of ORSS were categorized as group 2. The characteristics of the patients and renal stones, as well as the treatment modalities, were reviewed retrospectively, and the results were compared in terms of the rates of stone-free patients and complications.
Results: The stone-free rates were statistically lower in patients with an existing history of ORSS (p = 0.002), especially for stones located at the lower calyx (p = 0.006). However, there were no differences between groups in the rate of complications (p = 0.75). History of ipsilateral ORSS, age, and stone burden were independent risk factors that predicted a stone-free status in the regression analysis (p = 0.016, p = 0.045, and p = 0.001, respectively).
Conclusion: The overall stone-free rate after SWL was found to be significantly lower in children with a history of ORSS than in those without, and this finding was significantly prominent for lower calyx stones. In spite of the possible difficulties in achieving surgical access due to anatomical changes in retrograde intrarenal surgery or mini-/micro-percutaneous nephrolithotomy, we believe that these techniques might be good alternatives for SWL in future cases
Urol Int. 2020 Aug 28;1-7. doi: 10.1159/000509563. Online ahead of print. PMID: 32862182
The question formulated by the authors was if children previously subjected to open surgery had a less successful outcome of SWL. To get an answer to that question 315 children were retrospectively examined.
Without previous OS: 274 (Group 1)
With previous OS: 41 (Group 2)
Children in the latter group had a dominance of stones located in the lower calyx and a larger proportion of stones > 20 mm.
The outcome was associated with the stone burden, previous OS and age. There was a pronounced statistical difference for stones in the lower calyx.
SFR was 78% in Group 1 and 56% in group 2.
The explanation the authors provide for this difference is that the previous OS negatively had affected the intrarenal propulsive peristaltic activity. This is a reasonable explanation, but it is of note that there was no information on the geometric anatomy of the lower calyx in the two groups.