Extracorporeal Shockwave Lithotripsy Still Alive for Pediatric Ureteral Stones ≤1.0 cm²

This retrospective study compares extracorporeal shockwave lithotripsy (SWL) and ureteroscopy (URS) in pediatric ureteral stones ≤1.0 cm², aiming to determine the optimal treatment based on clinical outcomes.

The study included patients with ureteral stones ≤1.0 cm² eligible for SWL or URS. Treatment choices were made based on family decisions. SWL was performed under sedation, with 180° rotation for distal stones, whereas URS was conducted under general anesthesia using semirigid/flexible ureteroscopes with Ho:YAG laser lithotripsy. Complications were classified using Satava and Clavien criteria, respectively.

A total of 230 children (median age:7 y/o, interquartile range 4-12) underwent SWL (n = 129, 56%) or URS (n = 101, 44%)for ureteral stones ≤1.0 cm². The groups were comparable in terms of demographic characteristics. SWL and URS had comparable stone-free rates (85% vs 80, p = 0.276), and there was no difference according to the location. However, URS had a higher overall complication rate (16% vs 4%, p = 0.005). Complication rates were significantly higher for distal stones treated with URS (p = 0.009), whereas stone-free rates were similar between proximal (p = 0.821) and distal stones (p = 0.332). Logistic regression analysis revealed that female gender and stone burden were significant factors in achieving overall stone-free status. When stone-free outcomes were evaluated based on stone location, female gender and a history of previous minimally invasive stone intervention were also found to be influential predictors.

These findings indicate that SWL and URS provide comparable efficacy in stone clearance, but URS is associated with a higher complication rate, particularly for distal ureteral stones. Additionally, our data suggest that SWL remains a preferable first-line option, particularly for stones ≤1.0 cm², whereas URS might be reserved for cases with larger stone burdens or prior treatment failures.