SWL literature
SWL Literature

Guler Y. et al., 2020: Comparison of extracorporeal shockwave lithotripsy and retrograde intrarenal surgery in the treatment of renal pelvic and proximal ureteral stones 2 cm in children

Guler Y, Erbin A.
Department of Urology, Private Safa Hospital, Istanbul, Turkey.
Department of Urology, Haseki Traning and Research Hospital, Istanbul, Turkey.

Abstract

Introduction: We aimed to compare extracorporeal shockwave lithotripsy (ESWL) and retrograde intrarenal surgery (RIRS) in pediatric patients with ≤2 cm renal pelvis and proximal ureteral stones.

Methods: Medical records of 165 pediatric patients who underwent shockwave lithotripsy (SWL) or RIRS for upper urinary system stones up to 2 cm between January 2014 and December 2018 were retrospectively reviewed. After exclusions, the remaining 130 patients included 73 in the SWL group and 57 in the RIRS group. The groups were compared for demographic features, stone characteristics, operative data, success, and complications.

Results: The mean stone volume was 308 ± 85 (54-800) and 336 ± 96 (60-720) mm3 in SWL and RIRS groups, respectively (P = 0.46). There were no significant differences in success rates (60% vs. 70%, SWL and RIRS), auxiliary treatment rates (16.4% vs. 14%), and complication rates (26% vs. 24.5%). The number of active procedural sessions and number of anesthesia sessions was higher in the RIRS group (P < 0.001 and P < 0.001, respectively), while the procedural time and anesthesia time were higher in the SWL group (P < 0.001 and P < 0.001, respectively). Stone size was found to be an independent success predictive factor for both the treatment modalities.

Conclusions: Both SWL and RIRS have similar success, complication, and auxiliary treatment rates. RIRS was superior in terms of total procedure and anesthesia durations, while SWL was superior in terms of numbers of anesthesia sessions and active procedure sessions. As both have similar success rates, the more minimally invasive SWL should be chosen for pediatric upper urinary system stones of less than 2 cm size.

Indian J Urol. 2020 Oct-Dec;36(4):282-287. doi: 10.4103/iju.IJU_116_20. Epub 2020 Oct 1. PMID: 33376264. FREE ARTICLE

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Comments 1

Hans-Göran Tiselius on Wednesday, April 14 2021 08:30

This report summarizes the authors’ experience of SWL and RIRS for stones in the kidney and ureter. (The title is slightly misleading because stones were located both in the renal pelvis and in the calyces and in the text the authors use these different anatomical definitions). The study is retrospective, and it is not stated how the children were referred to the two treatment modalities. 73 children were primarily treated with SWL and 57 with RIRS.

There are two statements that need a comment:
“...lower chance of success for cystine stones.” Although these stones might be more difficult to treat it is not necessary to exclude them from SWL because some of these stones formed early in life might have a brittle structure and accordingly can be disintegrated more easily than such stones in adults. It is, however, not mentioned if cystine stones were part of the problem in these two patient groups.

“…one [stone] in the ureter and the other in a calyx or renal pelvis cannot have SWL for all stones at the same time”. If the stone burden is not excessive and the ureter stone breaks easily, there is no hinder to continue with SWL of the renal stone in the same session.
The data in this article allowed for calculation of the previously published STI [1], but it needs to be emphasized that this index is not meant to be used for children because to divergent age and BMI factors. Nevertheless, STI for SWL was approximately 0.15 and that for RIRS 0.13. The indices are remarkably similar and does not emphasise the advantages usually demonstrated for SWL because all children required anaesthesia.

Bottomline: Both treatment modalities were equally effective but the need of pre-stenting before RIRS is a negative factor.

Reference.
Tiselius HG, Ringdén I. Stone treatment index: A mathematical summary of the procedure for removal of stones from the urinary tract. J Endourol. 2007;21:1261-1269

Hans-Göran Tiselius

This report summarizes the authors’ experience of SWL and RIRS for stones in the kidney and ureter. (The title is slightly misleading because stones were located both in the renal pelvis and in the calyces and in the text the authors use these different anatomical definitions). The study is retrospective, and it is not stated how the children were referred to the two treatment modalities. 73 children were primarily treated with SWL and 57 with RIRS. There are two statements that need a comment: “...lower chance of success for cystine stones.” Although these stones might be more difficult to treat it is not necessary to exclude them from SWL because some of these stones formed early in life might have a brittle structure and accordingly can be disintegrated more easily than such stones in adults. It is, however, not mentioned if cystine stones were part of the problem in these two patient groups. “…one [stone] in the ureter and the other in a calyx or renal pelvis cannot have SWL for all stones at the same time”. If the stone burden is not excessive and the ureter stone breaks easily, there is no hinder to continue with SWL of the renal stone in the same session. The data in this article allowed for calculation of the previously published STI [1], but it needs to be emphasized that this index is not meant to be used for children because to divergent age and BMI factors. Nevertheless, STI for SWL was approximately 0.15 and that for RIRS 0.13. The indices are remarkably similar and does not emphasise the advantages usually demonstrated for SWL because all children required anaesthesia. Bottomline: Both treatment modalities were equally effective but the need of pre-stenting before RIRS is a negative factor. Reference. Tiselius HG, Ringdén I. Stone treatment index: A mathematical summary of the procedure for removal of stones from the urinary tract. J Endourol. 2007;21:1261-1269 Hans-Göran Tiselius
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