Presented by: Muhammet Demirbilek MD
Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine

Introduction

We compared the effectiveness of shock wave lithotripsy (SWL) and ureterorenoscopy (URS) in the treatment of ureteral stones ≤ 10 mm².

Materials

Children presented ureteral stone ≤10 mm² stone burden, and whom had been treated either with SWL or flexible/semirigid URS were included in the study(1998-2021). Factors related with outcome (detection of no stone in radiological evaluations a month after the treatment was accepted as stone-free, and any size of stone fragment regarded as failure) and complication (determined according to Satava and modified Clavian classifications) were evaluated regarding the patients, stones and treatment characteristics.

Results

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Of 153 patients with a median age of 7(1-17) were treated with SWL(n=89;58%) and URS(n=64;42%). According to comparison based on treatment protocols (SWL/URS) patients have similar gender distributions(p=0.869), stone locations(distal/proximal;p=0.869) and stone burden(p=0.869). Patients that underwent URS are relatively younger (p=0.008), and have a higher rate of a previous history of stone surgery(p=0.003).According to comparison based on outcome; the age(p=0.655), gender(p=0.229), side (p=0.304), and stone burden (p=0.304) were similar for the patients that had a stone free status and residual stones. Stone free status is similar for SWL and URS (91% vs 83%; p=0.129). Nevertheless; success rates are lower for distal ureter stones treated with URS (67%;p=0.009). Complication rates were found to be higher in the group with residual stones (26%;p=0.035).

Conclusion

We conclude that SWL was found to be effective for the treatment of ureter stones ≤ 10 mm² in children. Lower stone free status rates in the treatment of distal ureter stones with URS was surprising. The factors related to the patient and ureter, independent of localization and size, may be effective in this result, that we should focus on further studies.  

Funding

None.

Lead Authors

Elif Altınay Kırlı, MD
Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine

Engin Dereköylü, MD
Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine

Feyyaz Irmak, MD
Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine

Bülent Önal, MD
Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine