Lu P et al, 2015: The clinical efficacy of extracorporeal shock wave lithotripsy in pediatric urolithiasis: a systematic review and meta-analysis.
Lu P, Wang Z, Song R, Wang X, Qi K, Dai Q, Zhang W, Gu M.
Department of Urology, The First Affiliated Hospital With Nanjing Medical University, Nanjing, China.
The aim was to investigate the clinical efficacy and safety of extracorporeal shock wave lithotripsy (ESWL) in pediatric urolithiasis. A comprehensive systematic review and meta-analysis were performed. PubMed, Embase, and the Cochrane central register of controlled trials (CENTRAL) were searched, and the stone-free rates (SFRs) of various stone sizes and stone positions were extracted from the eligible articles. The quality of the original articles was assessed according to the McHarm Scale. The risk ratios (RRs) and 95 % confidential intervals (CIs) were pooled, and the sensitive analysis was performed to evaluate the heterogeneity among all eligible studies. In total, 14 studies with 1842 patients were identified. The pooled RR for the SFR of stones less than 10 mm and greater than 10 mm was 1.14 (95 % CI: 1.07, 1.21, P < 0.001); the RR for the SFR of stones in the renal pole calix (PC) and the renal pelvis was 0.95 (95 % CI: 0.893, 1.009,
P < 0.01); the RR for the SFR of stones in the upper/middle PC and the lower PC was 1.07 (95 % CI: 0.997, 1.156, P < 0.061); and the RR for the SFR of stones in the proximal ureter and middle/distal ureter was 1.077 (95 % CI: 1.005, 1.154, P = 0.036). Heterogeneity was low in all the analyses. Major complications in ESWL of pediatric urolithiasis were steinstrasse and abdominal colic, the incidences of which were 6.00 and 6.29 %, respectively. The SFR of stones <10 mm was significantly higher than stones >10 mm, and the SFR of stones located in proximal ureter was statistically greater than stones in middle or distal ureter in pediatric urolithiasis, leaving no significant between stones in renal PC and renal pelvis, or between upper/middle PC and lower PC. The use of ESWL in children is highly efficient, with negligible complications; ESWL therapy could be considered the first-line treatment for pediatric urolithiasis.
Urolithiasis. 2015 Feb 27. [Epub ahead of print]
This meta-analysis of ESWL for active removal of stones in children disclosed excellent results. These results are in line with my own experience and I agree with the authors that ESWL should be considered as first line treatment in children. The powerful ureter enables elimination of fragments more efficiently than in adults. The higher stone-free rate for proximal ureteral stones compared with that in the mid/distal ureter probably reflects inappropriate techniques used for treatment of stones in the latter positions.