Comparison of ultrasound-guided and fluoroscopy-guided shockwave lithotripsy in infants under 24 months

To compare the efficacy and safety of ultrasound (US)- and fluoroscopy (FL)-guided extracorporeal shock wave lithotripsy (SWL) in infants with urolithiasis.

Medical records of children aged < 24 months treated with SWL between 2007 and 2022 were retrospectively evaluated. Patients with non-opaque stones, urinary system anomalies, skeletal malformations, coagulopathy, or previous double-J catheter insertion were excluded from the study. The SWL procedure was performed under sedoanalgesia using ultrasonography or fluoroscopy as the imaging modality. Demographic and stone characteristics, stone-free rates, complications, and re-treatments were compared between the two groups.

A total of 137 patients underwent SWL, including 106 in the US group and 31 in the FL group. The mean age of patients was similar between groups (16.9 vs 18.1 months, p = 0.859), as was the mean stone size (9.4 vs 9.6 mm, p = 0.944). The stone-free rates after the final SWL session were 91.5% and 90.3% in the US and FL groups, respectively (p = 0.839). In the US group, 40 patients (37.7%) required re-treatment, compared to 9 patients (29.0%) in the FL group (p = 0.610). The efficacy quotients were comparable (63.4% vs 65.1%). The complication rates in the US and FL groups were 4.2% and 6.5%, respectively (p = 0.702).

US- and FL-guided SWL demonstrated similar efficacy and safety in the treatment of infantile urolithiasis. However, the absence of radiation exposure with US-guided SWL makes it a safer option. To our knowledge, this is the first direct comparison of these imaging modalities in an infant-only cohort, highlighting the potential benefits of US-guided SWL in this uniquely vulnerable population.