Slow vs Rapid Delivery Rate Shock Wave Lithotripsy for Pediatric Renal Urolithiasis: A Prospective Randomized Study

Abstract

We compared slow vs fast shock wave frequency rates in disintegration of pediatric renal stones less than 20 mm. Our study included 60 children with solitary 10 to 20 mm radiopaque renal stones treated with shock wave lithotripsy. Patients were prospectively randomized into 2 groups, ie those undergoing lithotripsy at a rate of 80 shock waves per minute (group 1, 30 patients) and those undergoing lithotripsy at a rate of 120 shock waves per minute (group 2, 30 patients). The 2 groups were compared in terms of treatment success, anesthesia time, secondary procedures and efficiency quotient. Stone clearance rate was significantly higher in group 1 (90%) than in group 2 (73.3%, p = 0.025). A total of 18 patients in group 1 (60%) were rendered stone-free after 1 session, 8 required 2 sessions and 1 needed 3 sessions, while shock wave lithotripsy failed in 3 patients. By comparison, 8 patients (26.6%) in group 2 were rendered stone-free after 1 session, 10 (33.3%) required 2 sessions and 4 (13.3%) needed 3 sessions to become stone-free. Mean general anesthesia time was significantly longer in group 1 (p = 0.041). Postoperatively 2 patients in group 1 and 4 in group 2 suffered low grade fever (Clavien grade II). Significantly more secondary procedures (percutaneous nephrolithotomy, repeat shock wave lithotripsy) were required in group 2 (p = 0.005). The predominant stone analysis was calcium oxalate dihydrate in both groups. Efficiency quotient was 0.5869 and 0.3437 for group 1 and group 2, respectively (p = 0.0247). In children with renal stones slow delivery rates of shock wave lithotripsy have better results regarding stone clearance than fast delivery rates.