Preface
As the world's largest and most influential urology academic conference, the annual meeting of the American Urological Association (AUA) was held in San Antonio, USA from May 3 to 6 local time. The plenary session specially set up a Practice-changing, Paradigm-shifting (P2s) summary report session, in which the clinical studies that are about to break the pattern of clinical practice and bring breakthrough impact are displayed in a unified manner, which has attracted much attention! Professor Gregory Tasian from Children's Hospital of Philadelphia reported the results of a multi-center prospective clinical trial of ureteroscopy versus shock wave lithotripsy in children with kidney stones, providing strong evidence support for the application of shock wave lithotripsy in children with urinary tract stones.
Background:
The AUA and European Urological Association (EAU) guidelines recommend the use of ureteroscopy (URS) or shock wave lithotripsy (SWL) for children with kidney stones < 20 mm and ureteral stones, but these recommendations are based on low-level evidence for stone clearance (quality of evidence: C) and no evidence from patient-reported outcomes (PROs). Although URS and SWL are equally weighted in the recommendation, 80% of children with nephrolithiasis are still treated with URS in clinical practice.
Research Methods:
During 2020-2023, the Pediatric Kidney Stone Care Improvement Network (PKIDS) conducted a prospective observational trial in children aged 8-21 years at 30 medical centers in North America comparing URS and SWL in renal and ureteral stones. The primary endpoint of the study is to assess stone clearance by ultrasonography at 6 (±2) weeks postoperatively. Secondary endpoints were patient-reported outcomes (PROs) assessed at 1, 3, 6 and 12 weeks postoperatively via the Patient Reported Outcome Measurement Information System (PROMIS) and urinary tract symptom scores.
Findings:
The study included 1070 children who received URS and 197 children who received SWL, and the distribution of age, sex, and ethnicity was consistent between the two groups. The median stone size was 6 mm (IQR 4,9) in the URS group and 7 mm (IQR 6,9) in the SWL group.
After adjusting for differences between groups, there was no statistically significant difference in the URS and SWL groups for urinary tract stones of different locations and sizes (only 3 children in the SWL group had stones > 15 mm, not analyzable), and the stone clearance rates were 74.5% (95% CI 65.7, 83.3), respectively, (risk difference [RD]=5.9, 95% CI -6.6, 18.5).
SWL was associated with a reduction in pain intensity, pain disturbances, and urinary tract symptoms in the week postoperatively compared to URS. There was no difference between the two treatment modalities in terms of any PROs from 3 weeks postoperatively to the last postoperative 3-month assessment.
Conclusions of the study
In children with renal and ureteral stones, SWL had similar stone clearance rates and reported better quality of life compared with URS. These results support the use of SWL treatment for children and adolescents with small to moderate urinary tract stones.
Resources:
[1] https://doi.org/10.1097/01.JU.0001015816.87470.c9.09
编辑:Gardenia审校:Gardenia执行:Gardenia
This platform aims to deliver more medical information to healthcare professionals. The content published on this platform should not be used as a substitute for professional medical guidance in any way, nor should it be regarded as diagnosis and treatment advice. If such information is used for purposes other than understanding medical information, the platform does not assume relevant responsibilities. This platform does not mean that it agrees with its descriptions and views on the published content. If copyright issues are involved, please contact us, and we will deal with it as soon as possible.
Yimaitong is a professional online doctor platform, and the mission of the platform is to "sense the pulse of the world's medicine and help China's clinical decision-making". Yimaitong has a series of products such as "Clinical Guidelines", "Medication Reference", "Medical Literature King", "Yizhiyuan", "eYantong" and "ePulse", which fully meet the needs of medical workers in clinical decision-making, obtaining new knowledge and improving scientific research efficiency.