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Effects of Double J Stent (DJS) Placement Before Pediatric ESWL on Complications and Stone-free Rates
Efe Bosnali1, Nazim Mutlu2, Kutlucan Cakmak2
1University of Health Sciences, Derince Training and Research Hospital, Department of Urology, Kocaeli, Turkey.
Insights
Pre-ESWL double J stenting (DJS) in children did not improve stone-free rates or reduce complications. This study found DJS placement had no impact on extracorporeal shock wave lithotripsy (ESWL) success or steinstrasse formation in pediatric urolithiasis patients.
Area of Science:
- Pediatric Urology
- Nephrology
- Surgical Innovation
Background:
- Pediatric urolithiasis is a significant global health concern.
- Extracorporeal shock wave lithotripsy (ESWL) is a primary treatment for pediatric upper urinary tract stones.
- The role of pre-ESWL double J stenting (DJS) in children remains unclear.
Purpose of the Study:
- To evaluate the impact of pre-ESWL DJS on stone-free rates (SFRs) in pediatric patients.
- To assess the effect of pre-ESWL DJS on complication rates following ESWL.
- To determine if DJS placement influences steinstrasse (SS) formation in children undergoing ESWL.
Main Methods:
- Retrospective analysis of 277 pediatric renal units treated with ESWL.
- Comparison of outcomes between patients with (DJS+) and without (DJS-) pre-ESWL stenting.
- Utilized Clavien-Dindo grading for complications and logistic regression for SS risk factors.
Main Results:
- No significant difference in SFR (60.6% vs. 68.4%) or complication rates (15.2% vs. 14.3%) between DJS+ and DJS- groups.
- DJS placement did not reduce the risk of steinstrasse formation (p=0.97).
- Stone size was the sole independent predictor of steinstrasse (OR: 1.13).
Conclusions:
- Pre-ESWL DJS does not enhance ESWL success in pediatric urolithiasis.
- Ureteral stenting prior to ESWL does not affect complication rates in children.
- DJS placement does not prevent steinstrasse formation in pediatric patients treated with ESWL.
Background:
Pediatric urolithiasis remains a significant health problem in certain regions worldwide. Extracorporeal shock wave lithotripsy (ESWL) is the preferred treatment for upper urinary tract stones smaller than 20 mm in children due to its ease of application and efficacy. However, the utility of double J stenting (DJS) before ESWL in pediatric patients is still debatable. This study aims to evaluate the impact of DJS placement prior to ESWL on children's complication and stone-free rates (SFRs).
Objectives:
To determine the effect of pre-ESWL double J stent (DJS) application on stone-freeness and complications in the pediatric age group.
Study Design:
This retrospective study included 277 renal units from 268 pediatric patients (≤18 years) treated with ESWL at Kocaeli University between 2006 and 2024. Patients were divided into two groups: those with (DJS+) and without (DJS-) pre-ESWL stenting. Demographic and clinical data, including outcomes and complications, were compared between the groups using univariate analyses. The Clavien-Dindo grading system was used to evaluate complications after ESWL. Multiple logistic regression analysis was performed to determine the factors affecting the risk of steinstrasse (SS) formation.
Results:
A total of 277 renal units were included in the study: 33 (13.1 %) with pre-ESWL DJ stents and 244 (86.9 %) without stents. 150 (54.1 %) of the patients were male, and the mean age was 7.32 ± 4.8. The mean stone size was 9.7 ± 3.3 mm. The DJS + group (33 RUs) and DJS- group (244 RUs) showed no significant difference in SFR (60.6 % vs. 68.4 %, p = 0.36) and complication rates (15.2 % vs. 14.3 %, p = 0.79). A total of 40 (14.4 %) cases had complications following ESWL. Of these complications, 24 (8.7 %) were major (Clavien Grade 3) and 16 (5.8 %) were minor (Clavien Grade 1-2). In addition, DJS placement did not reduce the risk of steinstrasse (SS) formation (p = 0.97). Multiple logistic regression identified stone size as the only independent predictor of SS formation (OR: 1.13, 95 % CI: 1.01-1.26, p = 0.02).
Discussion:
Unlike adult studies, studies reporting the effects of pre-ESWL ureteral stent placement in children are limited. To our knowledge, the present study has the highest number of patients in the literature evaluating the effects of pre-ESWL ureteral stent use on success and complications in treating urolithiasis with ESWL in the pediatric population. In addition, the findings of our study may contribute to the literature due to the limited number of studies investigating the effect of ureteral stents before ESWL in the pediatric age group and their small sample size.
Conclusions:
This study showed that pre-ESWL DJS application in the pediatric age group did not increase ESWL success, had no effect on post-ESWL complications and did not prevent the development of steinstrasse.
