Login to Access Video or Poster Abstract: MP66-15
Sources of Funding: None

Introduction

With the rising incidence of pediatric nephrolithiasis, the management debate between ureteroscopy (URS) and shockwave lithotripsy (SWL) has become more important. To date, success and complication rates for both have been based on single-institution reports. The aim of this study was to analyze the reported data on the effectiveness of SWL and URS for ureteral stones in children.

Methods

We searched Cochrane Controlled Trials Register, clinicaltrials.gov, MEDLINE, and EMBASE for reports in any language. Inclusion criteria were age <18 yrs with ureteral stones who underwent surgical treatment (URS vs SWL) with clearly defined success and complication rate. Manuscripts were then assessed and data abstracted in duplicate, with differences resolved by the senior author. Bias was assessed using standardized instruments. Pooled success and complication rates were estimated.

Results

We identified a total of 3,356 studies: 99 met inclusion criteria. The overall success rate was 0.80 (95% CI: 0.76-0.83) for SWL and 0.89 (95% CI: 0.86-0.91) for URS. The success rate for URS increased with more distal location: 0.83 (95% CI: 0.73-0.90) for proximal; 0.96 (95% CI: 0.87-0.99) for mid; and 0.94 (95% CI: 0.91-0.97) for distal ureteral stones. By contrast, SWL success decreased more distally: proximal 0.90 (95%CI: 0.83-0.95), mid 0.87 (95% CI: 0.79-0.92), and distal ureter 0.83 (95% CI: 0.72-0.90), respectively. _x000D_ _x000D_ The overall complication rate was not significantly different between the two modalities (SWL 0.04 (95% CI: 0.03-0.06) vs URS 0.06 (95% CI: 0.04-0.09)). Statistically significant heterogeneity was detected in all groups and subgroups of studies (p<0.001). However, little significant publication bias was detected._x000D_ _x000D_ _x000D_

Conclusions

Compared to SWL, URS was associated with higher overall success rate and similar risk of complications. URS was associated with higher success in treating mid-distal ureteral stones. By contrast, SWL was most successful in treating proximal ureteral stones.

Funding

None