Skip to main content
SpringerLink
Log in

The clinical efficacy of extracorporeal shock wave lithotripsy in pediatric urolithiasis: a systematic review and meta-analysis

  • Review
  • Published:
Urolithiasis Aims and scope Submit manuscript

Abstract

The aim was to investigate the clinical efficacy and safety of extracorporeal shock wave lithotripsy (ESWL) in pediatric urolithiasis. A comprehensive systematic review and meta-analysis were performed. PubMed, Embase, and the Cochrane central register of controlled trials (CENTRAL) were searched, and the stone-free rates (SFRs) of various stone sizes and stone positions were extracted from the eligible articles. The quality of the original articles was assessed according to the McHarm Scale. The risk ratios (RRs) and 95 % confidential intervals (CIs) were pooled, and the sensitive analysis was performed to evaluate the heterogeneity among all eligible studies. In total, 14 studies with 1842 patients were identified. The pooled RR for the SFR of stones less than 10 mm and greater than 10 mm was 1.14 (95 % CI: 1.07, 1.21, P < 0.001); the RR for the SFR of stones in the renal pole calix (PC) and the renal pelvis was 0.95 (95 % CI: 0.893, 1.009, P < 0.01); the RR for the SFR of stones in the upper/middle PC and the lower PC was 1.07 (95 % CI: 0.997, 1.156, P < 0.061); and the RR for the SFR of stones in the proximal ureter and middle/distal ureter was 1.077 (95 % CI: 1.005, 1.154, P = 0.036). Heterogeneity was low in all the analyses. Major complications in ESWL of pediatric urolithiasis were steinstrasse and abdominal colic, the incidences of which were 6.00 and 6.29 %, respectively. The SFR of stones <10 mm was significantly higher than stones >10 mm, and the SFR of stones located in proximal ureter was statistically greater than stones in middle or distal ureter in pediatric urolithiasis, leaving no significant between stones in renal PC and renal pelvis, or between upper/middle PC and lower PC. The use of ESWL in children is highly efficient, with negligible complications; ESWL therapy could be considered the first-line treatment for pediatric urolithiasis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Ds M (2009) Urolithiasis. Pediatric nephrology. springer 2009:1405–1430

    Google Scholar 

  2. Xiaoping CXL (2005) Surgery. People’s Publishing House 2011:593–594

    Google Scholar 

  3. Cohen TD, Ehreth J, King LR, Preminger GM (1996) Pediatric urolithiasis: medical and surgical management. Urology 47:292–303

    Article  CAS  PubMed  Google Scholar 

  4. Kroovand RL (1997) Pediatric urolithiasis. Urol Clin North Am 24:173–184

    Article  CAS  PubMed  Google Scholar 

  5. Minevich E (2001) Pediatric urolithiasis. Pediatr Clin North Am 48:1571–1585

    Article  CAS  PubMed  Google Scholar 

  6. Chaussy C, Schmiedt E, Jocham D, Brendel W, Forssmann B, Walther V (1982) First clinical experience with extracorporeally induced destruction of kidney stones by shock waves. J Urol 127:417–420

    CAS  PubMed  Google Scholar 

  7. Ghalayini IF, Al-Ghazo MA, Khader YS (2006) Extracorporeal shockwave lithotripsy versus ureteroscopy for distal ureteric calculi: efficacy and patient satisfaction. Int Braz J urol Off J Braz Soc Urol 32:656–664 (discussion 64–67)

    Article  Google Scholar 

  8. Logarakis NF, Jewett MA, Luymes J, Honey RJ (2000) Variation in clinical outcome following shock wave lithotripsy. J Urol 163:721–725

    Article  CAS  PubMed  Google Scholar 

  9. Lifshitz DA, Lingeman JE, Zafar FS, Hollensbe DW, Nyhuis AW, Evan AP (1998) Alterations in predicted growth rates of pediatric kidneys treated with extracorporeal shockwave lithotripsy. J Endourol Endourolog Soc 12:469–475

    Article  CAS  Google Scholar 

  10. Habib EI, Morsi HA, Elsheemy MS, Aboulela W, Eissa MA (2013) Effect of size and site on the outcome of extracorporeal shock wave lithotripsy of proximal urinary stones in children. J Pediatr Urol 9:323–327

    Article  PubMed  Google Scholar 

  11. Jeong US, Lee S, Kang J, Han DH, Park KH, Baek M (2013) Factors affecting the outcome of extracorporeal shock wave lithotripsy for unilateral urinary stones in children: a 17-year single-institute experience. Kor J Urol 54:460–466

    Article  Google Scholar 

  12. Badawy AA, Saleem MD, Abolyosr A, Aldahshoury M, Elbadry MS, Abdalla MA et al (2012) Extracorporeal shock wave lithotripsy as first line treatment for urinary tract stones in children: outcome of 500 cases. Int Urol Nephrol 44:661–666

    Article  PubMed  Google Scholar 

  13. Tricco AC, Cogo E, Angeliki VA, Soobiah C, Hutton B, Hemmelgarn BR et al (2014) Comparative safety of anti-epileptic drugs among infants and children exposed in utero or during breastfeeding: protocol for a systematic review and network meta-analysis. System Rev 3:68

    Article  Google Scholar 

  14. Biondi-Zoccai G, Lotrionte M, Landoni G, Modena MG (2011) The rough guide to systematic reviews and meta-analyses. HSR Proce Int Care Cardiovasc Anesthesia 3:161–173

    CAS  Google Scholar 

  15. DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7:177–188

    Article  CAS  PubMed  Google Scholar 

  16. Ather MH, Noor MA (2003) Does size and site matter for renal stones up to 30-mm in size in children treated by extracorporeal lithotripsy? Urology 61:212–215 (discussion 5)

    Article  PubMed  Google Scholar 

  17. Demirkesen O, Onal B, Tansu N, Altintas R, Yalcin V, Oner A (2006) Efficacy of extracorporeal shock wave lithotripsy for isolated lower caliceal stones in children compared with stones in other renal locations. Urology 67:170–174 (discussion 4–5)

    Article  PubMed  Google Scholar 

  18. Lu J, Sun X, He L, Wang Y (2009) Efficacy of extracorporeal shock wave lithotripsy for ureteral stones in children. Pediatr Surg Int 25:1109–1112

    Article  PubMed  Google Scholar 

  19. Penn HA, DeMarco RT, Sherman AK, Gatti JM, Murphy JP (2009) Extracorporeal shock wave lithotripsy for renal calculi. J Urol 182:1824–1827

    Article  PubMed  Google Scholar 

  20. Aksoy Y, Ozbey I, Atmaca AF, Polat O (2004) Extracorporeal shock wave lithotripsy in children: experience using a mpl-9000 lithotriptor. World J Urol 22:115–119

    Article  PubMed  Google Scholar 

  21. Slavkovic A, Radovanovic M, Vlajkovic M, Novakovic D, Djordjevic N, Stefanovic V (2006) Extracorporeal shock wave lithotripsy in the management of pediatric urolithiasis. Urol Res 34:315–320

    Article  CAS  PubMed  Google Scholar 

  22. Tekin I, Tekgul S, Bakkaloglu M, Kendi S (1998) Results of extracorporeal shock wave lithotripsy in children, using the Dornier MPL 9000 lithotriptor. J Pediatr Surg 33:1257–1259

    Article  CAS  PubMed  Google Scholar 

  23. Shouman AM, Ghoneim IA, ElShenoufy A, Ziada AM (2009) Safety of ungated shockwave lithotripsy in pediatric patients. J Pediatr Urol 5:119–121

    Article  PubMed  Google Scholar 

  24. Muslumanoglu AY, Tefekli AH, Altunrende F, Karadag MA, Baykal M, Akcay M (2006) Efficacy of extracorporeal shock wave lithotripsy for ureteric stones in children. Int Urol Nephrol 38:225–229

    Article  PubMed  Google Scholar 

  25. Kuvezdic H, Tucak A, Peric N, Prlic D, Zoric I, Galic R (2003) ESWL treatment of urinary stones in children–the overview of 14 years of experience. Coll Antropol 27(Suppl 1):71–75

    PubMed  Google Scholar 

  26. Hammad FT, Kaya M, Kazim E (2009) Pediatric extracorporeal shockwave lithotripsy: its efficiency at various locations in the upper tract. J Endourol Endourolog Soc 23:229–235

    Article  Google Scholar 

  27. Kerbl K, Rehman J, Landman J, Lee D, Sundaram C, Clayman RV (2002) Current management of urolithiasis: progress or regress? J Endourol Endourolog Soc 16:281–288

    Article  Google Scholar 

  28. Warmerdam GJ, De Laet K, Wijn RP, Wijn PF (2012) Treatment options for active removal of renal stones. J Med Eng Technol 36:147–155

    Article  CAS  PubMed  Google Scholar 

  29. Paterson RF, Lifshitz DA, Kuo RL, Siqueira TM Jr, Lingeman JE (2002) Shock wave lithotripsy monotherapy for renal calculi. Int Braz J Urol Off J Braz Soc Urol 28:291–301

    Google Scholar 

  30. Stamatiou KN, Heretis I, Takos D, Papadimitriou V, Sofras F (2010) Extracorporeal shock wave lithotripsy in the treatment of pediatric urolithiasis: a single institution experience. Int Braz J Urol Off J Braz Soc Urol 36:724–730 (discussion 31)

    Article  Google Scholar 

  31. Gofrit ON, Pode D, Meretyk S, Katz G, Shapiro A, Golijanin D et al (2001) Is the pediatric ureter as efficient as the adult ureter in transporting fragments following extracorporeal shock wave lithotripsy for renal calculi larger than 10 mm.? J Urol 166:1862–1864

    Article  CAS  PubMed  Google Scholar 

  32. Brinkmann OA, Griehl A, Kuwertz-Broking E, Bulla M, Hertle L (2001) Extracorporeal shock wave lithotripsy in children. Efficacy, complications and long-term follow-up. Eur Urol 39:591–597

    Article  CAS  PubMed  Google Scholar 

  33. Rodrigues Netto N Jr, Longo JA, Ikonomidis JA, Rodrigues Netto M (2002) Extracorporeal shock wave lithotripsy in children. J Urol 167:2164–2166

    Article  PubMed  Google Scholar 

  34. Bader MJ, Eisner B, Porpiglia F, Preminger GM, Tiselius HG (2012) Contemporary management of ureteral stones. Eur Urol 61:764–772

    Article  PubMed  Google Scholar 

  35. Lam JS, Greene TD, Gupta M (2002) Treatment of proximal ureteral calculi: holmium:YAG laser ureterolithotripsy versus extracorporeal shock wave lithotripsy. J Urol 167:1972–1976

    Article  PubMed  Google Scholar 

  36. Eisenmenger W, Du XX, Tang C, Zhao S, Wang Y, Rong F et al (2002) The first clinical results of “wide-focus and low-pressure” ESWL. Ultrasound Med Biol 28:769–774

    Article  CAS  PubMed  Google Scholar 

  37. Goktas C, Akca O, Horuz R, Gokhan O, Albayrak S, Sarica K (2011) SWL in lower calyceal calculi: evaluation of the treatment results in children and adults. Urology 78:1402–1406

    Article  PubMed  Google Scholar 

Download references

Acknowledgement

This project was sponsored by Science and Education Health Project of Jiangsu Province for important talent (RC2011055); “333 high level talents project” in Jiangsu province (2011); Jiangsu province six talents peak from Department of human resources, social security office of Jiangsu Province of China (2010WSN-56); General program of Department of Health of Jiangsu Province of China (H2009907); Science and Education Health Project of Jiangsu Province for key medical department (2007–2028).

Conflict of interest

The authors have declared that no competing interests exist.

Author information

Authors and Affiliations

  1. Department of Urology, The First Affiliated Hospital With Nanjing Medical University, Nanjing, China

    Pei Lu, Zijie Wang, Rijin Song, Xiaolan Wang, Kai Qi, Qiying Dai, Wei Zhang & Min Gu

Authors
  1. Pei Lu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Zijie Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rijin Song
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Xiaolan Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kai Qi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Qiying Dai
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Wei Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Min Gu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Min Gu.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lu, P., Wang, Z., Song, R. et al. The clinical efficacy of extracorporeal shock wave lithotripsy in pediatric urolithiasis: a systematic review and meta-analysis. Urolithiasis 43, 199–206 (2015). https://doi.org/10.1007/s00240-015-0757-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00240-015-0757-5

Keywords

Search

Navigation