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Methods of treating pediatric ureteral stones compared

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Transureteral lithotripsy seems to deal with distal ureteral calculi in young children more effectively than shockwave lithotripsy, as long as appropriate instruments and skills are available, according to an Iranian study.

Dr. Abbas Basiri and colleagues at Shahid Beheshti University, Tehran, note in the Journal of Urology for September that the development of small caliber instruments has made ureteroscopy for removing ureteral calculi feasible in pediatric patients. However, data on the pros and cons of minimally invasive methods of treating ureteral stones in children are limited.

The investigators therefore compared shockwave lithotripsy to transureteral lithotripsy with holmium laser and pneumatic lithotriptor in a randomized trial involving 100 children (mean age 6.5 years) with distal ureteral stones.

The stone-free rate at discharge was 38% in the shockwave lithotripsy group and 66% in the transureteral group (p=0.002). At 2 weeks, corresponding rates still differed significantly at 56% and 78% (p=0.004).

Repeat treatment was required in 38% of children in the shockwave group and in 18% of those in the transureteral group. With a repeat shockwave lithotripsy session, stone clearance increased to 72%, compared with 88% after a second transureteral treatment.

Minor complication rates were similar in the two treatment arms. However, ureteral perforation occurred in two children treated with transureteral lithotripsy.

Summing up, the authors write: “It is difficult to draw definitive conclusions about the safety and efficacy of these modalities. However, transureteral lithotripsy appears to be associated with a superior outcome and satisfaction compared to shockwave lithotripsy when a small caliber ureteroscope can be used.”

Reference:

A Multicenter, Randomized, Controlled Trial of Transureteral and Shock Wave Lithotripsy—Which is the Best Minimally Invasive Modality to Treat Distal Ureteral Calculi in Children?

J Urol 2010;184:1106-1110.