Savun Metin, Caglar Ufuk, Ayranci Ali, Sekerel Levent Denis, Sarilar Omer, Ozgor Faruk
Department of Urology, University of Health Sciences, Basaksehir Cam and Sakura City Hospital, 34480, Istanbul, Türkiye.
Department of Urology, University of Health Sciences, Haseki Training and Research Hospital, 34480, Istanbul, Türkiye.
Int Urol Nephrol. 2025 Sep;57(9):2893-2898. doi: 10.1007/s11255-025-04608-w. Epub 2025 Jun 16.
To compare the efficacy and safety of ultrasound (US)- and fluoroscopy (FL)-guided extracorporeal shock wave lithotripsy (SWL) in infants with urolithiasis.
Medical records of children aged < 24 months treated with SWL between 2007 and 2022 were retrospectively evaluated. Patients with non-opaque stones, urinary system anomalies, skeletal malformations, coagulopathy, or previous double-J catheter insertion were excluded from the study. The SWL procedure was performed under sedoanalgesia using ultrasonography or fluoroscopy as the imaging modality. Demographic and stone characteristics, stone-free rates, complications, and re-treatments were compared between the two groups.
A total of 137 patients underwent SWL, including 106 in the US group and 31 in the FL group. The mean age of patients was similar between groups (16.9 vs 18.1 months, p = 0.859), as was the mean stone size (9.4 vs 9.6 mm, p = 0.944). The stone-free rates after the final SWL session were 91.5% and 90.3% in the US and FL groups, respectively (p = 0.839). In the US group, 40 patients (37.7%) required re-treatment, compared to 9 patients (29.0%) in the FL group (p = 0.610). The efficacy quotients were comparable (63.4% vs 65.1%). The complication rates in the US and FL groups were 4.2% and 6.5%, respectively (p = 0.702).
US- and FL-guided SWL demonstrated similar efficacy and safety in the treatment of infantile urolithiasis. However, the absence of radiation exposure with US-guided SWL makes it a safer option. To our knowledge, this is the first direct comparison of these imaging modalities in an infant-only cohort, highlighting the potential benefits of US-guided SWL in this uniquely vulnerable population.
比较超声（US）引导和荧光透视（FL）引导的体外冲击波碎石术（SWL）治疗婴儿尿路结石的疗效和安全性。
回顾性评估2007年至2022年间接受SWL治疗的年龄小于24个月儿童的病历。研究排除了患有透X线结石、泌尿系统异常、骨骼畸形、凝血功能障碍或先前已插入双J导管的患者。SWL手术在镇静镇痛下进行，使用超声或荧光透视作为成像方式。比较两组患者的人口统计学和结石特征、结石清除率、并发症及再次治疗情况。
共有137例患者接受了SWL治疗，其中US组106例，FL组31例。两组患者的平均年龄相似（16.9个月对18.1个月，p = 0.859），平均结石大小也相似（9.4毫米对9.6毫米，p = 0.944）。最后一次SWL治疗后的结石清除率在US组和FL组分别为91.5%和90.3%（p = 0.839）。US组中有40例患者（37.7%）需要再次治疗，而FL组为9例患者（29.0%）（p = 0.610）。疗效商数相当（63.4%对65.1%）。US组和FL组的并发症发生率分别为4.2%和6.5%（p = 0.702）。
US引导和FL引导的SWL在治疗婴儿尿路结石方面显示出相似的疗效和安全性。然而，US引导的SWL不存在辐射暴露，使其成为更安全的选择。据我们所知，这是首次在仅包含婴儿的队列中对这些成像方式进行直接比较，突出了US引导的SWL在这一特别脆弱人群中的潜在益处。
