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Review
. 2019 Oct 9;10(10):CD010784.
doi: 10.1002/14651858.CD010784.pub3.

Medical and surgical interventions for the treatment of urinary stones in children

Lenka Barreto  1 , Jae Hung Jung, Ameera Abdelrahim, Munir Ahmed, Guy P C Dawkins, Marcin Kazmierski
Affiliations
Review

Medical and surgical interventions for the treatment of urinary stones in children

Lenka Barreto et al. Cochrane Database Syst Rev. .

Abstract

Background: Urolithiasis is a condition where crystalline mineral deposits (stones) form within the urinary tract. Urinary stones can be located in any part of the urinary tract. Affected children may present with abdominal pain, blood in the urine or signs of infection. Radiological evaluation is used to confirm the diagnosis, to assess the size of the stone, its location, and the degree of possible urinary obstruction.

Objectives: To assess the effects of different medical and surgical interventions in the treatment of urinary tract stones of the kidney or ureter in children.

Search methods: We searched the Cochrane Register of Controlled Trials (CENTRAL), MEDLINE (Ovid), Embase (Ovid) as well as the World Health Organization International Clinical Trials Registry Platform Search Portal and ClinicalTrials.gov. We searched reference lists of retrieved articles and conducted an electronic search for conference abstracts for the years 2012 to 2017. The date of the last search of all electronic databases was 31 December 2017 and we applied no language restrictions.

Selection criteria: We included all randomised controlled trials (RCTs) and quasi-RCTs looking at interventions for upper urinary tract stones in children. These included shock wave lithotripsy, percutaneous nephrolithotripsy, ureterorenoscopy, open surgery and medical expulsion therapy for upper urinary tract stones in children aged 0 to 18 years.

Data collection and analysis: We used standard methodological procedures according to Cochrane guidance. Two review authors independently searched and assessed studies for eligibility and conducted data extraction. 'Risk of bias' assessments were completed by three review authors independently. We used Review Manager 5 for data synthesis and analysis. We used the GRADE approach to assess the quality of evidence.

Main results: We included 14 studies with a total of 978 randomised participants in our review, informing eight comparisons. The studies contributing to most comparisons were at high or unclear risk of bias for most domains.Shock wave lithotripsy versus dissolution therapy for intrarenal stones: based on one study (87 participants) and consistently very low quality evidence, we are uncertain about the effects of SWL on stone-free rate (SFR), serious adverse events or complications of treatment and secondary procedures for residual fragments.Slow shock wave lithotripsy versus rapid shock wave lithotripsy for renal stones: based on one study (60 participants) and consistently very low quality evidence, we are uncertain about the effects of SWL on SFR, serious adverse events or complications of treatment and secondary procedures for residual fragments.Shock wave lithotripsy versus ureteroscopy with holmium laser or pneumatic lithotripsy for renal and distal ureteric stones: based on three studies (153 participants) and consistently very low quality evidence, we are uncertain about the effects of SWL on SFR, serious adverse events or complications of treatment and secondary procedures.Shock wave lithotripsy versus mini-percutaneous nephrolithotripsy for renal stones: based on one study (212 participants), SWL likely has a lower SFR (RR 0.88, 95% CI 0.80 to 0.97; moderate quality evidence); this corresponds to 113 fewer stone-free patients per 1000 (189 fewer to 28 fewer). SWL may reduce severe adverse events (RR 0.13, 95% CI 0.02 to 0.98; low quality evidence); this corresponds to 66 fewer serious adverse events or complications per 1000 (74 fewer to 2 fewer). Rates of secondary procedures may be higher (RR 2.50, 95% CI 1.01 to 6.20; low-quality evidence); this corresponds to 85 more secondary procedures per 1000 (1 more to 294 more).Percutaneous nephrolithotripsy versus tubeless percutaneous nephrolithotripsy for renal stones: based on one study (23 participants) and consistently very low quality evidence, we are uncertain about the effects of percutaneous nephrolithotripsy on SFR, serious adverse events or complications of treatment and secondary procedures.Percutaneous nephrolithotripsy versus tubeless mini-percutaneous nephrolithotripsy for renal stones: based on one study (70 participants), SFR are likely similar (RR 1.03, 95% CI 0.93 to 1.14; moderate-quality evidence); this corresponds to 28 more per 1,000 (66 fewer to 132 more). We did not find any data relating to serious adverse events. Based on very low quality evidence we are uncertain about secondary procedures.Alpha-blockers versus placebo with or without analgesics for distal ureteric stones: based on six studies (335 participants), alpha-blockers may increase SFR (RR 1.34, 95% CI 1.16 to 1.54; low quality evidence); this corresponds to 199 more stone-free patients per 1000 (94 more to 317 more). Based on very low quality evidence we are uncertain about serious adverse events or complications and secondary procedures.

Authors' conclusions: Based on mostly very low-quality evidence for most comparisons and outcomes, we are uncertain about the effect of nearly all medical and surgical interventions to treat stone disease in children.Common reasons why we downgraded our assessments of the quality of evidence were: study limitations (risk of bias), indirectness, and imprecision. These issues make it difficult to draw clinical inferences. It is important that affected individuals, clinicians, and policy-makers are aware of these limitations of the evidence. There is a critical need for better quality trials assessing patient-important outcomes in children with stone disease to inform future guidelines on the management of this condition.

PubMed Disclaimer

Conflict of interest statement

LB: none known.

AA: none known.

JHJ: none known.

MA: none known.

GPCD: none known.

MK: none known.

Figures

1
1
Flow diagram.
2
2
'Risk of bias' graph: review authors' judgements about each 'Risk of bias' item presented as percentages across all included studies.
3
3
'Risk of bias' summary: review authors' judgements about each 'Risk of bias' item for each included study.
1.1
1.1. Analysis
Comparison 1 Shock wave lithotripsy versus dissolution therapy for renal stones, Outcome 1 Stone‐free rate.
1.2
1.2. Analysis
Comparison 1 Shock wave lithotripsy versus dissolution therapy for renal stones, Outcome 2 Serious adverse events or complications.
1.3
1.3. Analysis
Comparison 1 Shock wave lithotripsy versus dissolution therapy for renal stones, Outcome 3 Secondary procedures.
2.1
2.1. Analysis
Comparison 2 Slow shock wave lithotripsy versus rapid shock wave lithotripsy for renal stones, Outcome 1 Stone‐free rate.
2.2
2.2. Analysis
Comparison 2 Slow shock wave lithotripsy versus rapid shock wave lithotripsy for renal stones, Outcome 2 Serious adverse events or complications.
2.3
2.3. Analysis
Comparison 2 Slow shock wave lithotripsy versus rapid shock wave lithotripsy for renal stones, Outcome 3 Secondary procedures.
3.1
3.1. Analysis
Comparison 3 Shock wave lithotripsy versus ureteroscopy with holmium laser or pneumatic lithotripsy for renal and ureteric stones, Outcome 1 Stone‐free rate.
3.2
3.2. Analysis
Comparison 3 Shock wave lithotripsy versus ureteroscopy with holmium laser or pneumatic lithotripsy for renal and ureteric stones, Outcome 2 Serious adverse events or complications of treatment.
3.3
3.3. Analysis
Comparison 3 Shock wave lithotripsy versus ureteroscopy with holmium laser or pneumatic lithotripsy for renal and ureteric stones, Outcome 3 Second procedures.
3.4
3.4. Analysis
Comparison 3 Shock wave lithotripsy versus ureteroscopy with holmium laser or pneumatic lithotripsy for renal and ureteric stones, Outcome 4 Hospital stay (hours).
4.1
4.1. Analysis
Comparison 4 Shock wave lithotripsy versus mini‐percutaneous nephrolithotripsy for renal stones, Outcome 1 Stone‐free rate.
4.2
4.2. Analysis
Comparison 4 Shock wave lithotripsy versus mini‐percutaneous nephrolithotripsy for renal stones, Outcome 2 Serious adverse events or complications of treatment.
4.3
4.3. Analysis
Comparison 4 Shock wave lithotripsy versus mini‐percutaneous nephrolithotripsy for renal stones, Outcome 3 Secondary procedures.
4.4
4.4. Analysis
Comparison 4 Shock wave lithotripsy versus mini‐percutaneous nephrolithotripsy for renal stones, Outcome 4 Hospital stay (days).
5.1
5.1. Analysis
Comparison 5 Percutaneous nephrolithotripsy versus tubeless percutaneous nephrolithotripsy for renal stones, Outcome 1 Stone‐free rate.
5.2
5.2. Analysis
Comparison 5 Percutaneous nephrolithotripsy versus tubeless percutaneous nephrolithotripsy for renal stones, Outcome 2 Serious adverse events or complications of treatments.
5.3
5.3. Analysis
Comparison 5 Percutaneous nephrolithotripsy versus tubeless percutaneous nephrolithotripsy for renal stones, Outcome 3 Secondary procedures.
5.4
5.4. Analysis
Comparison 5 Percutaneous nephrolithotripsy versus tubeless percutaneous nephrolithotripsy for renal stones, Outcome 4 Hospital stay (hours).
5.5
5.5. Analysis
Comparison 5 Percutaneous nephrolithotripsy versus tubeless percutaneous nephrolithotripsy for renal stones, Outcome 5 Pain (dose of morphine).
6.1
6.1. Analysis
Comparison 6 Percutaneous nephrolithotripsy versus tubeless mini‐percutaneous nephrolithotripsy for renal stones, Outcome 1 Stone‐free rate.
6.2
6.2. Analysis
Comparison 6 Percutaneous nephrolithotripsy versus tubeless mini‐percutaneous nephrolithotripsy for renal stones, Outcome 2 Secondary procedures.
6.3
6.3. Analysis
Comparison 6 Percutaneous nephrolithotripsy versus tubeless mini‐percutaneous nephrolithotripsy for renal stones, Outcome 3 Hospital stay (days).
7.1
7.1. Analysis
Comparison 7 Alpha‐blockers versus placebo with/without analgesics for distal ureteric stones, Outcome 1 Stone‐free rate.
7.2
7.2. Analysis
Comparison 7 Alpha‐blockers versus placebo with/without analgesics for distal ureteric stones, Outcome 2 Serious adverse events or complications of treatments.
7.3
7.3. Analysis
Comparison 7 Alpha‐blockers versus placebo with/without analgesics for distal ureteric stones, Outcome 3 Secondary procedures.
7.4
7.4. Analysis
Comparison 7 Alpha‐blockers versus placebo with/without analgesics for distal ureteric stones, Outcome 4 Pain (episode).
See this image and copyright information in PMC

Update of

  • doi: 10.1002/14651858.CD010784.pub2

References

References to studies included in this review

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Saad 2015 {published data only}
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