Objective: Shockwave lithotripsy (SWL) remains a well-established treatment modality for many of the pediatric renal and ureteral stones. Repeated SWL sessions carry limitations due to the use of general anesthesia and X-ray radiation. The objective of our study was to evaluate stone-free rate (SFR) of 1-session of SWL for the management of pediatric renal and ureteral stones less than 2 cm performed exclusively under ultrasound guidance and identify factors influencing its success.
Methods: The study utilized a retrospective cohort design including 124 consecutive pediatric patients with 133 renal and ureteral stones less than 2 cm whom SWL was performed in the period of January 2008 to December 2019. SWL procedures were performed by one expert surgeon in a single, national reference center, exclusively under ultrasound guidance using Modulith® SLK lithotripter. Follow-up was performed in post-SWL 2nd, 4th, 12th weeks and 6 months.
Results: The mean age of the children was 10 years (SD = 6.0) and the mean stone size was 10.4 mm (SD = 3.6 mm). Sedation type of anesthesia was used in 80 patients (64.5%). No major complication was developed, and no ureteral stenting was required in any of the patient following SWL. The SFR following 1-session of SWL was 88.0% at 12-week. Younger age (P = 0.002), sedation type of anesthesia (P = 0.001) and presence of radiolucent stones (P = 0.033) significantly improved post-SWL early stone clearance on univariate analysis, the latter being the only significant factor according to final model (P = 0.031).
Conclusions: Ultrasound-guided SWL represents a safe and effective method for the management of both renal and ureteral stones in children. The SFR following 1-session of SWL at 12-weeks was achieved in 88.0%, the overall success rate after all SWL sessions reaching 91.7%. A higher success rate was observed in children harboring radiolucent stones.
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