Telli O et al, 2015: What is the best option for 10-20mm renal pelvic stones undergoing ESWL in the pediatric population: stenting, alpha blockers or conservative follow-up?
Telli O, Gokce MI, Ozturk E, Suer E, Mermerkaya M, Afandiyev F, Ozcan C, Guclu AG, Soygur T, Burgu B.
Ankara University, School of Medicine, Department of Pediatric Urology, Ankara, Turkey
OBJECTIVE: In this study we aimed to identify the effect of three different modalities (stenting, doxazosin and conservative follow-up) on stone free rates and complication rates for 10-20mm renal pelvic stones in pediatric patients who underwent shock wave lithotripsy.
PATIENTS AND METHODS: In this study data from 241 renal units (RUs) of 195 consecutive patients with 10-20mm renal pelvis stones were analyzed retrospectively. There were 3 groups in the study; 56 (23.2%) RUs with ureteral stenting were categorized as group 1, and 39 (16.2%) RUs that received doxazosin were categorized as group 2. The remaining 146 (60.6%) RUs without history of ureteral stenting or alpha-blockers usage were categorized as group 3. Patient demographics, stone characteristics, stone free rates (SFRs), time to stone expulsion and complications were documented and compared in each group.
RESULTS: Mean age of the population was 6.6years and mean stone size was 13.8±2.9mm. Demographic characteristics of the 3 groups were not significantly different. SFRs of the three groups were 89.2%, 87.1% and 82.1% (p=0.275). Mean time to stone expulsion for groups 1 and 2 were 17.4 and 21.8days respectively and significantly lower than that in group 3 (31.3days).
CONCLUSIONS: Ureteral stenting or doxazosin for shockwave lithotripsy (SWL) is not superior to watchful waiting in terms of SFR and complications however both modalities shorten the stone expulsion time for 10-20mm renal pelvis stones in the pediatric population.
J Pediatr Surg. 2014 Nov 28. pii: S0022-3468(14)00791-X. doi: 10.1016/j.jpedsurg.2014.11.045. [Epub ahead of print]
This is a relatively large series of children with renal pelvic stones with a mean stone size of
13.8 ± 2.9 mm treated with ESWL within a short time period of only 2 ½ years. As such it is an interesting paper, but …
“Decision of either ureteral stenting or doxazosin prescription was based on the physician’s decision.”
The frequency of Steinstrasse was 3,57%, in the stent group, 5,12 % in the doxazosin group and 2.05 % in the control group respectively.
No data are available on stone radiopacity, density or analysis. Thus a large bias of patient selection cannot be excluded; the results may depend on factors not controlled and the conclusions are not justified. There is a need for well-done studies on stone treatment: Low Methodological and Reporting Quality of Randomized, Controlled Trials of Devices to Treat Urolithiasis. Peter J. Zavitsanos, Vincent G. Bird, Kathryn A. Mince, Molly M. Neuberger and Philipp Dahm. J.Urol Vol. 191, 988-993, April 2014.