Editorial Comment from Dr Sato to Extracorporeal shockwave lithotripsy for renal stones in pediatric patients: A multivariate analysis model for estimating the stone‐free probability

Abstract

Currently, shockwave lithotripsy (SWL) is still considered the least invasive procedure for stone management in children, despite increasing application of percutaneous nephrolithotomy (PCNL), and ureteroscopy (URS) (development of smaller-diameter flexible ureteroscopes). These treatment modalities are highly effective for children with stone disease. Increased use of SWL for large stone burdens would necessitate increased numbers of lithotriptors, repeated treatment sessions and relief for postoperative urinary obstruction as a result of residual fragments. Although children have a greater ability to excrete fragments than adults, significant residual stone fragments often require other treatment approaches, such as URS. To make optimal future decisions, we need further information to define a clear size cut-off for treating uncomplicated upper urinary tract stone with SWL. This article provides some useful new data.1 The present study proposes stone size guidelines for each stone location for SWL in children using multivariate logistic regression analysis. These conclusions are significant, although other studies proposed smaller stone sizes than are recommended as suitable for SWL in children in the present report.2 In the present study, 11 and 3 patients required URS and PNS for significant urinary obstruction by steinstrasses after SWL, respectively. The authors judged them success cases, but not treatment failures, because residual fragments after SWL are considered a complication. However, significant urinary obstruction as a result of stone fragments cannot be managed by SWL-monotherapy. These obstructive conditions required rescue by URS or percutaneous nephrostomy (PNS). The authors should mention the stone size and the locations of the cases that required other treatment modalities (URS and PNS). More detail on these cases could increase the value of this study. Notwithstanding, this information is of practical importance and should help in making clinical decisions, especially in determining cut-off size for SWL monotherapy. None declared.