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.
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.
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].
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.
World journal of urology. 2023 Jan 04 [Epub ahead of print]
Nikolaos Chatzikrachtis, Lazaros Tzelves, Robert Geraghty, Ioannis Manolitsis, Patrick Juliebø-Jones, Amelia Pietropaolo, Markos Karavitakis, Marinos Berdempes, Titos Markopoulos, Bhaskar Somani, Andreas Skolarikos
2nd Department of Urology, National and Kapodistrian University of Athens, Sismanogleio Hospital, Athens, Greece., Department of Urology, The Newcastle upon Tyne Hospitals NHS Foundation, Newcastle upon Tyne, UK., 2nd Department of Urology, National and Kapodistrian University of Athens, Sismanogleio Hospital, Athens, Greece. ., Young Academic Urologists (YAU), Urolithiasis and Endourology Working Party, 6846, Arnhem, The Netherlands., Department of Urology, University General Hospital of Heraklion, University of Crete Medical School, Heraklion, Crete, Greece., Department of Urology, University Hospital Southampton NHS Trust, Southampton, SO16 6YD, UK.