Skip to main content

Advertisement

SpringerLink
Log in

Complication rate after pediatric shock wave lithotripsy according to Clavien–Dindo grading system: results from a systematic review and meta-analysis of the existing literature

  • Original Article
  • Published:
World Journal of Urology Aims and scope Submit manuscript

Abstract

Purpose

Shockwave lithotripsy (SWL) is a minimally invasive technique utilized for renal and ureteric stones in children. Despite being considered safe, certain complications have been recorded. We performed this systematic review and meta-analysis to provide a pooled analysis of Clavien–Dindo graded complications after SWL in children.

Methods

MEDLINE/PubMed, Scopus and Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews, were screened from inception to 12/02/2022 by two authors independently. Only randomized controlled trials providing Clavien–Dindo classification or relevant clinical information were considered eligible. Overall complications were calculated using the aggregate number of each complication divided by the total number of patients in studies with data.

Results

Pooled analysis revealed that from children treated with SWL, 27.7% [95% CI 13.1–49.4] suffered Clavien I complications, 4.9% [95% CI 3.1–7.6] Clavien II complications, 2.7% [95% CI 1.6–4.7] Clavien III complications, 2.3% [95% CI 1.3–4] Clavien IV complications, while no Clavien V complications were recorded. In total, 28.1% [95% CI 15.6–45.3] of children suffered minor complications (Clavien–Dindo I–II), while 3% [95% CI 1.8–5] major complications (Clavien–Dindo III–V). Pooled analysis revealed that 10.7% [95% CI 3.2–30.1] of patients suffered macroscopic hematuria, 7.3% [95% CI 2.1–22.7] pain, 5.5% [95% CI 3.3–9] steinstrasse, 5.3% [95% CI 3–9.3] fever, 2.2% [95% CI 0.8–5.6] sepsis, 1.1% [95% CI 0.3–3.7] urinoma, 1% [95% CI 0.4–2.7] symptomatic hematoma and 1% [95% CI 0.3–2.7] asymptomatic hematoma. Need for re-treatment was 42.6% [95% CI 31.4–54.7] and need for auxiliary procedures was 11.8% [95% CI 8.5–16.1].

Conclusion

SWL is an irreplaceable tool for treating urolithiasis in children. Although a minimally invasive technique, parents and children should be adequately informed about the risk of minor/major complications.

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.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Data availability statement

All data generated or analysed during this study are included in this published article (and its supplementary information files).

References

  1. Alfandary H, Haskin O, Davidovits M, Pleniceanu O, Leiba A, Dagan A (2018) Increasing prevalence of nephrolithiasis in association with increased body mass index in children: a population based study. J Urol 199(4):1044–1049

    Article  PubMed  Google Scholar 

  2. Tekgül S (2015) Percutaneous nephrolithotomy vs retrograde intrarenal surgery for upper tract calculi in children-which is a better option for which stone condition? J Urol 194(6):1529–1530

    Article  PubMed  Google Scholar 

  3. Bogris S, Papatsoris AG (2010) Status quo of percutaneous nephrolithotomy in children. Urol Res 38(1):1–5

    Article  PubMed  Google Scholar 

  4. Radmayr CBG, Burgu B et al (2022) European Association of Urology (EAU) pediatric urology guidelines. EAU Guidelines Office, Arnhem

  5. Dogan HS, Altan M, Citamak B, Bozaci AC, Karabulut E, Tekgul S (2015) A new nomogram for prediction of outcome of pediatric shock-wave lithotripsy. J Pediatr Urol 11(2):84.e1–6

    Article  PubMed  Google Scholar 

  6. Onal B, Tansu N, Demirkesen O, Yalcin V, Huang L, Nguyen HT et al (2013) Nomogram and scoring system for predicting stone-free status after extracorporeal shock wave lithotripsy in children with urolithiasis. BJU Int 111(2):344–352

    Article  PubMed  Google Scholar 

  7. Ceyhan E, Ozer C, Ozturk B, Tekin MI, Aygun YC (2021) Ability of ESWL nomograms to predict stone-free rate in children. J Pediatr Urol 17(4):474.e1-474.e6

    Article  PubMed  Google Scholar 

  8. Skolarikos A, Alivizatos G, de la Rosette J (2006) Extracorporeal shock wave lithotripsy 25 years later: complications and their prevention. Eur Urol 50(5):981–990 (discussion 90)

    Article  PubMed  Google Scholar 

  9. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213

    Article  PubMed  PubMed Central  Google Scholar 

  10. Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 339:b2535

    Article  PubMed  PubMed Central  Google Scholar 

  11. Mittal V, Srivastava A, Kappor R, Ansari MS, Patidar N, Arora S et al (2016) Standardized grading of shock wave lithotripsy complications with modified Clavien system. Urol Int 97(3):273–278

    Article  PubMed  Google Scholar 

  12. Wells GA SB OCD, Peterson J et al (2016) The Newcastle–Ottawa Scale (NOS) for assessing the quality of nonrandomized studies in meta-analyses

  13. Hozo SP, Djulbegovic B, Hozo I (2005) Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol 5(1):13

    Article  PubMed  PubMed Central  Google Scholar 

  14. Wan X, Wang W, Liu J, Tong T (2014) Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Med Res Methodol 14(1):135

    Article  PubMed  PubMed Central  Google Scholar 

  15. Alsagheer GA, Mohamed O, Abdel-Kader MS, Hasan AM, Abdel Razek M, Fathi A et al (2018) Extracorporeal shock wave lithotripsy (ESWL) versus flexible ureteroscopy (F-URS) for management of renal stone burden less than 2 cm in children: a randomized comparative study. Afr J Urol 24(2):120–125

    Article  Google Scholar 

  16. Mokhless IA, Abdeldaeim HM, Saad A, Zahran AR (2014) Retrograde intrarenal surgery monotherapy versus shock wave lithotripsy for stones 10 to 20 mm in preschool children: a prospective, randomized study. J Urol 191(5 Suppl):1496–1499

    Article  PubMed  Google Scholar 

  17. Farouk A, Tawfick A, Shoeb M, Mahmoud MA, Mostafa DE, Hasan M et al (2018) Is mini-percutaneous nephrolithotomy a safe alternative to extracorporeal shockwave lithotripsy in pediatric age group in borderline stones? a randomized prospective study. World J Urol 36(7):1139–1147

    Article  PubMed  Google Scholar 

  18. Elderwy AA, Kurkar A, Hussein A, Abozeid H, Hammodda HM, Ibraheim AF (2014) Dissolution therapy versus shock wave lithotripsy for radiolucent renal stones in children: a prospective study. J Urol 191(5 Suppl):1491–1495

    Article  PubMed  Google Scholar 

  19. Kaygisiz O, Cicek MC, Mert A, Akesen S, Sarandol E, Kilicarslan H (2021) Which frequency is better for pediatric shock wave lithotripsy? Intermediate or low: a prospective randomized study. World J Urol 39(10):3963–3969

    Article  CAS  PubMed  Google Scholar 

  20. Salem HK, Fathy H, Elfayoumy H, Aly H, Ghonium A, Mohsen MA et al (2014) Slow vs rapid delivery rate shock wave lithotripsy for pediatric renal urolithiasis: a prospective randomized study. J Urol 191(5):1370–1374

    Article  PubMed  Google Scholar 

  21. Shahat A, Elderwy A, Safwat AS, Abdelkawi IF, Reda A, Abdelsalam Y et al (2016) Is tamsulosin effective after shock wave lithotripsy for pediatric renal stones? A randomized, controlled study. J Urol 195(4 Pt 2):1284–1288

    Article  CAS  PubMed  Google Scholar 

  22. Kumar A, Kumar N, Vasudeva P, Kumar R, Jha SK, Singh H (2015) A single center experience comparing miniperc and shockwave lithotripsy for treatment of radiopaque 1–2 cm lower caliceal renal calculi in children: a prospective randomized study. J Endourol 29(7):805–809

    Article  PubMed  Google Scholar 

  23. Basiri A, Zare S, Tabibi A, Sharifiaghdas F, Aminsharifi A, Mousavi-Bahar SH et al (2010) A multicenter, randomized, controlled trial of transureteral and shock wave lithotripsy–which is the best minimally invasive modality to treat distal ureteral calculi in children? J Urol 184(3):1106–1109

    Article  PubMed  Google Scholar 

  24. Tuncer M, Kafkaslı A, Can U, Çoşkun A, Eryıldırım B, Sarica K (2021) What is the optimal frequency in shock wave lithotripsy for pediatric renal stones? A prospective randomized study. Urolithiasis 49(4):377–383

    Article  PubMed  Google Scholar 

  25. Omran M, Sakr A, Desoky EAE, Ali MM, Abdalla MMH (2020) Miniature semi-rigid ureteroscopy with holmium-yttrium-aluminium-garnet laser vs shockwave lithotripsy in the management of upper urinary tract stones >1 cm in children. Arab J Urol 18(2):106–111

    Article  PubMed  PubMed Central  Google Scholar 

  26. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD et al (2021) The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 372:71. https://doi.org/10.1136/bmj.n71

    Article  Google Scholar 

  27. Raza A, Turna B, Smith G, Moussa S, Tolley DA (2005) Pediatric urolithiasis: 15 years of local experience with minimally invasive endourological management of pediatric calculi. J Urol 174(2):682–685

    Article  PubMed  Google Scholar 

  28. Tzelves L, Geraghty R, Mourmouris P, Chatzikrachtis N, Karavitakis M, Somani B et al (2021) shockwave lithotripsy complications according to modified Clavien-Dindo grading system. A systematic review and meta-regression analysis in a sample of 115 randomized controlled trials. Eur Urol Focus

  29. Smith A PG, Kavoussi L, Badlani G (2019). Smith’s textbook of endourology, 4th edition, pp 691–712

  30. Willis LR, Evan AP, Connors BA, Blomgren P, Fineberg NS, Lingeman JE (1999) Relationship between kidney size, renal injury, and renal impairment induced by shock wave lithotripsy. J Am Soc Nephrol 10(8):1753–1762

    Article  CAS  PubMed  Google Scholar 

  31. Muslumanoglu AY, Tefekli A, Sarilar O, Binbay M, Altunrende F, Ozkuvanci U (2003) Extracorporeal shock wave lithotripsy as first line treatment alternative for urinary tract stones in children: a large scale retrospective analysis. J Urol 170(6 Pt 1):2405–2408

    Article  PubMed  Google Scholar 

  32. VanderBrink BA, Gitlin J, Toro S, Palmer LS (2009) Effect of tamsulosin on systemic blood pressure and nonneurogenic dysfunctional voiding in children. J Urol 181(2):817–822

    Article  CAS  PubMed  Google Scholar 

Download references

Funding

This research received no external funding. Institutional Review Board Statement: The study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Institutional Review Board of Sismanogleio General Hospital (Ref.No 15179/2020). The authors Bhaskar Somani and Andreas Skolarikos are members of the editorial board of the World Journal of Urology.

Author information

Authors and Affiliations

  1. 2nd Department of Urology, National and Kapodistrian University of Athens, Sismanogleio Hospital, Athens, Greece

    Nikolaos Chatzikrachtis, Lazaros Tzelves, Ioannis Manolitsis, Marinos Berdempes, Titos Markopoulos & Andreas Skolarikos

  2. Young Academic Urologists (YAU), Urolithiasis and Endourology Working Party, 6846, Arnhem, The Netherlands

    Lazaros Tzelves, Patrick Juliebø-Jones & Amelia Pietropaolo

  3. Department of Urology, The Newcastle upon Tyne Hospitals NHS Foundation, Newcastle upon Tyne, UK

    Robert Geraghty

  4. Department of Urology, Haukeland University Hospital, Bergen, Norway

    Patrick Juliebø-Jones

  5. Department of Clinical Medicine, University of Bergen, Bergen, Norway

    Patrick Juliebø-Jones

  6. Department of Urology, University Hospital Southampton NHS Trust, Southampton, SO16 6YD, UK

    Amelia Pietropaolo & Bhaskar Somani

  7. Department of Urology, University General Hospital of Heraklion, University of Crete Medical School, Heraklion, Crete, Greece

    Markos Karavitakis

Authors
  1. Nikolaos Chatzikrachtis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lazaros Tzelves
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Robert Geraghty
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ioannis Manolitsis
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Patrick Juliebø-Jones
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Amelia Pietropaolo
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Markos Karavitakis
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Marinos Berdempes
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Titos Markopoulos
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Bhaskar Somani
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Andreas Skolarikos
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

NC: protocol development, data collection; LT: protocol development, data collection, data analysis; RG: data collection, data analysis; IM: data collection, manuscript writing; PJ-J: data collection, manuscript writing; AP: data collection, manuscript writing; MK: data collection, manuscript writing; MB: data collection, manuscript writing; TM: data collection, manuscript writing; BS: protocol development, data collection, manuscript editing; AS: protocol development, data collection, manuscript editing. All authors have read and agreed to the published version of the manuscript.

Corresponding author

Correspondence to Ioannis Manolitsis.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 15 KB)

Supplementary file2 (DOCX 18 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chatzikrachtis, N., Tzelves, L., Geraghty, R. et al. Complication rate after pediatric shock wave lithotripsy according to Clavien–Dindo grading system: results from a systematic review and meta-analysis of the existing literature. World J Urol 41, 829–835 (2023). https://doi.org/10.1007/s00345-022-04267-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00345-022-04267-x

Keywords

Search

Navigation