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Soleimani MJ. et al., 2023: Investigating ESWL success rate in the treatment of renal and ureteral stones in children

Friday, 09 June 2023

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Soleimani MJ, Shahrokh H, Soraki VV, Fakhar V, Ghaed MA, Narouie B.
Hasheminejad Kidney Center, Department of Urology, Iran University of Medical Sciences, Tehran, Iran.
Rasool Akram Medical Complex, Department of Urology, Iran University of Medical Sciences, Tehran, Iran.
Department of Urology, Zahedan University of Medical Sciences, Zahedan, Iran.

Abstract

Objective: Extracorporeal shock wave lithotripsy (ESWL) is one of the most important methods of treatment for stone in children. Therefore, this study was conducted to determine the success rate of ESWL in the treatment of kidney and ureteral stones in children referred to Hasheminejad kidney center during the second half of 2018.

Patients and methods: This observational prospective study was conducted on 144 children referred to Hasheminejad kidney center during the 2018. The patients were selected using the convenience sampling method. The study was investigating the success rate of ESWL in the treatment of kidney and ureteral stones and effective factors in this regard.

Results: A total of 133 patients (92.4%) had stone passage and 37.5% of patients had residual stones, 28.5% of which were less than 5 mm in diameter. Successful results were seen in 131 cases (91%). Successful results were significantly higher in males (p = 0.011) and lower in simultaneous stones in the middle calyx and lower calyx (p = 0.0001).

Conclusion: According to the results of this study, it can be inferred that ESWL success rate was above 90% in the treatment of kidney and ureteral stones in children in such a way that with an ESWL session in patients who have been properly selected for this procedure, a success rate of about 62.5% will be available to remove any residual fragments, and nearly 28.5% have residual fragments with a diameter of smaller than 5 mm, which is basically hopeful for a high urinary passage. The present study shows that type and stone location are the factors contributing to the successful ESWL and shows the female gender and the presence of stone in the lower and middle calyx are the risk factors for the lower ESWL success rate.
Urologia. 2023 Mar 18:3915603231162663. doi: 10.1177/03915603231162663. Online ahead of print. PMID: 36932948.

Comments 1

Hans-Göran Tiselius on Friday, 09 June 2023 10:30

In view of the common recommendation that SWL should be considered as first line treatment modality for stone removal in children, it is highly interesting to study the results presented in this report. The results of SWL were analyzed in 144 children with age 14 years. All of them were treated with a Dornier Compact Delta II lithotripter. This device is equipped with both US and X-ray systems, but it is not mentioned how these techniques practically were applied.

Below are some interesting notations from the artile:

Stone passage was recorded in 133 children, 92 %
Stone-free children were 90; 63 %
Residuals 5 mm were observed in 9 %
There were 131 children who were judged as successfully treated; 91 %
The success was greater in boys (98 %) than in girls (86%).
No explanation is provided why stones in the mid and distal ureter were excluded from SWL.
Why hematuria is recorded as a complication is difficult to understand. This is not a complication, but an expected consequence of stone disintegration. The question that can be raised is if children without hematuria were adequately treated or if they only had very soft stones?

It is interesting to note that for all children antibiotics were prescribed after SWL, why?

79% of the treated stones were radiopaque and 21% radiolucent. Stone composition is not reported (unknown?). It is reasonable to assume that the radiolucent stones were dominated by uric acid, but how many children had cystine stones?

Of note is that the stone size was not a determinant for successful stone disintegration. Another result that needs attention is that 100% of the upper ureteral stones were successfully treated. It is not explained, however, why lower calix stones were more successfully treated than middle and upper caliceal stones.

It should be observed that only 24% of the children were re-treated!
Although the results are impressive, one point of concern is that the long-term follow-up only was evaluated with US-scan.

Hans-Göran Tiselius

Below are some interesting notations from the artile:

Stone passage was recorded in 133 children, 92 %
Stone-free children were 90; 63 %
Residuals  5 mm were observed in 9 % 
There were 131 children who were judged as successfully treated; 91 %
The success was greater in boys (98 %) than in girls (86%).
No explanation is provided why stones in the mid and distal ureter were excluded from SWL.
Why hematuria is recorded as a complication is difficult to understand. This is not a complication, but an expected consequence of stone disintegration. The question that can be raised is if children without hematuria were adequately treated or if they only had very soft stones?

It is interesting to note that for all children antibiotics were prescribed after SWL, why?

79% of the treated stones were radiopaque and 21% radiolucent. Stone composition is not reported (unknown?). It is reasonable to assume that the radiolucent stones were dominated by uric acid, but how many children had cystine stones?

Of note is that the stone size was not a determinant for successful stone disintegration. Another result that needs attention is that 100% of the upper ureteral stones were successfully treated. It is not explained, however, why lower calix stones were more successfully treated than middle and upper caliceal stones.

It should be observed that only 24% of the children were re-treated!
Although the results are impressive, one point of concern is that the long-term follow-up only was evaluated with US-scan.

Hans-Göran Tiselius

In view of the common recommendation that SWL should be considered as first line treatment modality for stone removal in children, it is highly interesting to study the results presented in this report. The results of SWL were analyzed in 144 children with age 14 years. All of them were treated with a Dornier Compact Delta II lithotripter. This device is equipped with both US and X-ray systems, but it is not mentioned how these techniques practically were applied. Below are some interesting notations from the artile: Stone passage was recorded in 133 children, 92 % Stone-free children were 90; 63 % Residuals 5 mm were observed in 9 % There were 131 children who were judged as successfully treated; 91 % The success was greater in boys (98 %) than in girls (86%). No explanation is provided why stones in the mid and distal ureter were excluded from SWL. Why hematuria is recorded as a complication is difficult to understand. This is not a complication, but an expected consequence of stone disintegration. The question that can be raised is if children without hematuria were adequately treated or if they only had very soft stones? It is interesting to note that for all children antibiotics were prescribed after SWL, why? 79% of the treated stones were radiopaque and 21% radiolucent. Stone composition is not reported (unknown?). It is reasonable to assume that the radiolucent stones were dominated by uric acid, but how many children had cystine stones? Of note is that the stone size was not a determinant for successful stone disintegration. Another result that needs attention is that 100% of the upper ureteral stones were successfully treated. It is not explained, however, why lower calix stones were more successfully treated than middle and upper caliceal stones. It should be observed that only 24% of the children were re-treated! Although the results are impressive, one point of concern is that the long-term follow-up only was evaluated with US-scan. Hans-Göran Tiselius

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