What is the best option for 10–20 mm renal pelvic stones undergoing ESWL in the pediatric population: stenting, alpha blockers or conservative follow-up?

Abstract

ObjectiveIn this study we aimed to identify the effect of three different modalities (stenting, doxazosin and conservative follow-up) on stone free rates and complication rates for 10–20mm renal pelvic stones in pediatric patients who underwent shock wave lithotripsy. Patients and methodsIn this study data from 241 renal units (RUs) of 195 consecutive patients with 10–20mm renal pelvis stones were analyzed retrospectively. There were 3 groups in the study; 56 (23.2%) RUs with ureteral stenting were categorized as group 1, and 39 (16.2%) RUs that received doxazosin were categorized as group 2. The remaining 146 (60.6%) RUs without history of ureteral stenting or alpha-blockers usage were categorized as group 3. Patient demographics, stone characteristics, stone free rates (SFRs), time to stone expulsion and complications were documented and compared in each group. ResultsMean age of the population was 6.6years and mean stone size was 13.8±2.9mm. Demographic characteristics of the 3 groups were not significantly different. SFRs of the three groups were 89.2%, 87.1% and 82.1% (p=0.275). Mean time to stone expulsion for groups 1 and 2 were 17.4 and 21.8days respectively and significantly lower than that in group 3 (31.3days). ConclusionsUreteral stenting or doxazosin for shockwave lithotripsy (SWL) is not superior to watchful waiting in terms of SFR and complications however both modalities shorten the stone expulsion time for 10–20mm renal pelvis stones in the pediatric population.