Ureteral calculi in children: what is best as a minimally invasive modality?
Abbas Basiri1, Samad Zare, Nasser Shakhssalim
1Urology and Nephrology Research Center and Department of Urology, Shahid Labbafinejad Medical Center, Shahid Beheshti University (MC), Tehran, Iran. basiri@unrc.ir
Insights
Extracorporeal shock wave lithotripsy (SWL) and ureteroscopy are minimally invasive options for pediatric ureteral stones. Ureteroscopy showed higher success rates, but more research is needed due to limited high-quality studies.
Area of Science:
- Pediatric Urology
- Minimally Invasive Surgery
- Nephrolithiasis Management
Background:
- Pediatric ureteral calculi present a significant clinical challenge.
- Minimally invasive treatment options are continuously being evaluated for efficacy and safety.
- This review focuses on extracorporeal shock wave lithotripsy (SWL) and ureteroscopic modalities.
Purpose of the Study:
- To evaluate the efficacy and safety of SWL versus ureteroscopic treatment for pediatric ureteral calculi.
- To conduct an evidence-based review of existing literature.
- To identify gaps in current research regarding treatment outcomes.
Main Methods:
- A systematic review of PubMed-indexed articles from 1998 to March 2008 was performed.
- Studies focusing on SWL or ureteroscopic management of pediatric ureteral calculi were selected.
- The level of evidence for each study was determined, and data on success rates and treatment courses were extracted.
Main Results:
- Twenty-four articles were analyzed, with 6 randomized controlled trials and 18 retrospective studies.
- SWL success rates were 84.1% for upper and 76.2% for lower ureteral calculi; ureteroscopy success rates were 93.2% for lower and 74.4% for upper calculi.
- Multiple treatment sessions were required for a significant portion of patients in both groups.
Conclusions:
- Current evidence for minimally invasive treatment of pediatric ureteral calculi is limited by a lack of robust randomized controlled trials and prospective data.
- Insufficient patient numbers in existing studies hinder definitive conclusions.
- Further high-quality research is necessary to establish optimal treatment strategies.
Introduction:
Minimally invasive treatment of ureteral calculi in children is a challenging topic. In an evidence-based review, we evaluated the efficacy and safety of extracorporeal shock wave lithotripsy (SWL) and ureteroscopic modalities for this group of patients.
Materials And Methods:
In this study, we performed a comprehensive systematic review on articles appeared in the PubMed from 1998 to March 2008. We selected all papers addressing SWL or ureteroscopic management of the ureteral calculi in children and determined the level of evidence of the presenting data.
Results:
Thirty-nine articles were reviewed and 24 with valid information on SWL or ureteroscopic management of the pediatric ureteral calculi were analyzed. Six articles (25%) were randomized controlled trials and 18 (75%) were retrospective case-controls or case series. The following data were extracted from the 24 articles: in SWL groups, overall success rate was 84.1% (range, 71% to 100%) for the upper ureteral calculi and 76.2% (range, 19% to 91%) for the lower ureteral calculi. Only 61% of the patients had only 1 treatment course, while 8% and 31% of the cases required 2 and more than 2 sessions of treatment, respectively. With ureteroscopic management, the overall success rates were 93.2% (range, 81% to 100%) and 74.4% (range, 20% to 100%) in the lower and upper ureteral calculi, respectively.
Conclusion:
The main limitations of the series on minimally invasive treatment of pediatric ureteral calculi are lack of powerful randomized controlled trials or prospective data and insufficient patient numbers. Therefore, it is difficult to draw absolute conclusions about successful treatment based on current knowledge.
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