Tejwani et al. have undertaken a comparative effectiveness study to characterise differences in procedure frequency, postoperative re-admissions and emergency room (ER) visits, and repeat treatment rates for children (≤18 years) with urolithiasis who underwent initial intervention with extracorporeal shock wave lithotripsy (ESWL) or ureteroscopy (URS). State specific databases were analysed for California, Florida, North Carolina and Utah (2007-2010); they also looked at data from New York State (2008-2010). Primary outcomes included subsequent inpatient admission or ER visit within 30 or 90 days of the initial procedure, and additional stone procedures (ESWL or URS) undertaken within 365 days of the initial procedure. The authors identified 1087 and 1194 patients undergoing ESWL and URS respectively. Patients undergoing URS were more likely to have ureteral stone. Pre-stenting was undertaken in 4.2% of patients. Compared to URS patients, ESWL patients had a greater number of additional stone procedures within 12 months of initial treatment (18.8% vs. 13.6%; p=0.0007). Repeat ESWL was the most common repeat procedure. URS was associated with a higher rate of 30-day re-admissions (20.2% vs. 13.6%; P<0.0001), 30-day ER visits (8% vs. 5.2%; p=0.0071) and 90-day ER visits (11.9% vs. 9.3%; p=0.0443). The authors conclude that URS was used more commonly for the initial treatment of upper tract paediatric calculi than ESWL, with an increasing tendency in older patients and that although repeat treatment rates did not differ between procedures, URS patients were more likely to be seen in the ER or re-admitted within 30 days of the initial intervention. This paper provides an overview of procedural ‘trends’ but lacks necessary detailed patient clinical factors such as stone size, total stone burden, stone location, number and underlying metabolic abnormalities (all of which affect choice of initial intervention and need for repeat surgery). 

Outcomes of shock wave lithotripsy and ureteroscopy for treatment of pediatric urolithiasis.
Tejwani R, Wang H-H S, Wolf S, et al.
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Neil Featherstone

Cambridge University Hospitals NHS Foundation Trust (Addenbrookes Hospital).

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