Outcomes of Flexible Ureteroscopy vs Extracorporeal Shock Wave Lithotripsy for Renal Stones in Pediatric Patients: A European Association of Urology Urolithiasis Guidelines Systematic Review and Meta-Analysis

No AccessJournal of UrologyPediatric Urology1 Dec 2023Outcomes of Flexible Ureteroscopy vs Extracorporeal Shock Wave Lithotripsy for Renal Stones in Pediatric Patients: A European Association of Urology Urolithiasis Guidelines Systematic Review and Meta-AnalysisThis article is commented on by the following:Editorial Comment Robert Geraghty, Riccardo Lombardo, Cathy Yuan, Niall Davis, Lazaros Tzelves, Ales Petrik, Helene Jung, Giovanni Gambaro, Thomas Tailly, Andreas Neisius, Andreas Skolarikos, and Bhaskar Somani Robert GeraghtyRobert Geraghty , Riccardo LombardoRiccardo Lombardo , Cathy YuanCathy Yuan , Niall DavisNiall Davis , Lazaros TzelvesLazaros Tzelves , Ales PetrikAles Petrik , Helene JungHelene Jung , Giovanni GambaroGiovanni Gambaro , Thomas TaillyThomas Tailly , Andreas NeisiusAndreas Neisius , Andreas SkolarikosAndreas Skolarikos , and Bhaskar SomaniBhaskar Somani Correspondence: Department of Urology, University Hospital Southampton NHS Trust, Tremona Rd, Southampton, Hampshire SO16 6YD, UK telephone: 023 8077 7222; ([email protected]) https://orcid.org/0000-0002-6248-6478 View All Author Informationhttps://doi.org/10.1097/JU.0000000000003696AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We sought to determine which treatment between flexible ureteroscopy and shock wave lithotripsy has a better stone-free rate in pediatric patients (<18 years) with renal or proximal ureteric stones (<2 cm). Subanalysis for all outcomes for randomized controlled trials only. Materials and Methods: Using PubMed, Web of Science, and the Cochrane database, we identified studies (randomized clinical trials and prospective comparative nonrandomized studies) published until August 2022 reporting surgical outcomes of pediatrics patients undergoing flexible ureteroscopy and shock wave lithotripsy with renal or proximal ureteric stones <2 cm (PROSPERO ID: CRD42022378790). Only randomized controlled trials were considered for meta-analysis. Stone-free rate, operative time, and complications were analyzed. Analysis was performed in R. Results: A total of 6 studies identified, of which 3 were randomized clinical trials and 4 had data on renal stones. A total of 669 patients were analyzed. Mean age ranged from 4.4 to 12.4 years. The shock wave lithotripsy group presented a range of stone-free rate between 21 and 90% while the flexible ureteroscopy group presented a range of stone-free rates between 37% and 97%. Meta-analysis of randomized controlled trials only (n=302) demonstrated significantly higher stone-free rate in flexible ureteroscopy vs shock wave lithotripsy (RR = 1.17, 95% CI: 1.04-1.33, P = 0.01), operative time (mean difference = +16.4 minutes, 95% CI: 7.3-25.5, P < 0.01) and hospital stay (mean difference = +0.25 days, 95% CI: 0.14-0.36, P < 0.001). But no difference in fluoroscopy exposure time (mean difference = −21.0 seconds, 95% CI: −42.6 to 0.56, P = 0.07), Clavien I-II (RR = 1.23, 95% CI: 0.71-2.12, P = 0.45) or Clavien III-V complications (RR = 1.04, 95% CI: 0.32-3.42, P = 0.95). 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Instructions for obtaining credits are given with the questions on pages 932 and 933. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byWan J (2023) This Month in Pediatric UrologyJournal of Urology, VOL. 210, NO. 6, (829-829), Online publication date: 1-Dec-2023.Yong R, Nguyen C and Koh C (2023) Editorial CommentJournal of Urology, VOL. 210, NO. 6, (886-887), Online publication date: 1-Dec-2023.Related articlesJournal of Urology2 Oct 2023Editorial Comment Volume 210Issue 6December 2023Page: 876-887Supplementary Materials Peer Review Report Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.Keywordskidney calculiureteroscopyextracorporeal shock wave therapyguidelinetreatment outcomeMetrics Author Information Robert Geraghty More articles by this author Riccardo Lombardo More articles by this author Cathy Yuan More articles by this author Niall Davis More articles by this author Lazaros Tzelves More articles by this author Ales Petrik More articles by this author Helene Jung More articles by this author Giovanni Gambaro More articles by this author Thomas Tailly More articles by this author Andreas Neisius More articles by this author Andreas Skolarikos More articles by this author Bhaskar Somani Correspondence: Department of Urology, University Hospital Southampton NHS Trust, Tremona Rd, Southampton, Hampshire SO16 6YD, UK telephone: 023 8077 7222; ([email protected]) More articles by this author Expand All Support: None. Conflict of Interest Disclosures: GG: UpToDate, Alnylam, Roche Diagnostics, Alexion, Astra Zeneca, Astellas, Alfa Sigma, Baxter, Medtronic, Vifor Pharma, GSK, Lilly; TT: AMBU, BK Medical, Boston Scientific. All other authors have nothing to disclose. Ethics Statement: This study received Institutional Review Board approval (IRB No. CRD42022378790). Editor's Note: This article is the fourth of 5 published in this issue for which Category 1 CME credits can be earned. Instructions for obtaining credits are given with the questions on pages 932 and 933. Advertisement PDF downloadLoading ...