Effectiveness of ultrasound-guided shockwave lithotripsy and predictors of its success rate in pediatric population: A report from a national reference center

Arthur Grabsky; Arman Tsaturyan; Lusine Musheghyan; Gevorg Minasyan; Yervand Khachatryan; Gor Shadyan; Artur Qocharyan; Mkrtich Mosoyan; Panagiotis Kallidonis

doi:10.1016/j.jpurol.2020.10.014

Effectiveness of ultrasound-guided shockwave lithotripsy and predictors of its success rate in pediatric population: A report from a national reference center

J Pediatr Urol. 2021 Feb;17(1):78.e1-78.e7. doi: 10.1016/j.jpurol.2020.10.014. Epub 2020 Oct 20.

Authors

Arthur Grabsky¹, Arman Tsaturyan², Lusine Musheghyan³, Gevorg Minasyan⁴, Yervand Khachatryan⁴, Gor Shadyan¹, Artur Qocharyan¹, Mkrtich Mosoyan⁵, Panagiotis Kallidonis⁶

Affiliations

¹ Department of Urology, Yerevan State Medical University, Yerevan, Armenia; Department of Urology, Izmirlian Medical Center, Yerevan, Armenia.
² Department of Urology, Yerevan State Medical University, Yerevan, Armenia; Department of Urology, University Hospital of Bern, Bern, Switzerland. Electronic address: tsaturyanarman@yahoo.com.
³ Gerald and Patricia Turpanjian School of Public Health, American University of Armenia, Yerevan, Armenia.
⁴ Department of Urology, Yerevan State Medical University, Yerevan, Armenia.
⁵ Department of Urology and Robotic Surgery, Almazov National Medical Research Center, St. Petersburg, Russia.
⁶ Department of Urology, University General Hospital of Patras, Patras, Greece.

PMID: 33153916
DOI: 10.1016/j.jpurol.2020.10.014

Abstract

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.

Keywords: Pediatric urolithiasis; Renal stone; Shockwave lithotripsy; Ureteral stone.

MeSH terms

Child
Humans
Kidney Calculi* / diagnostic imaging
Kidney Calculi* / therapy
Lithotripsy*
Retrospective Studies
Treatment Outcome
Ultrasonography, Interventional
Ureteral Calculi* / diagnostic imaging
Ureteral Calculi* / therapy