Comparison of the results of shock wave lithotripsy with ultrasonic and fluoroscopic focus in pediatric age group; Fluoroscopic focusing how much is needed?

Abstract

Aim: Shock wave lithotripsy (SWL) is a well-known technique used in the treatment of kidney stones since the early eighties. Forsuccessful SWL, accurate visualization of the shock waves is performed by ultrasound (US) or fluoroscope (FS) to fully focus theshock waves on the stone. In this study, we aimed to investigate the effect of US and FS methods used for focusing on stone in SWLtreatment of renal stones in pediatric patients on side effect and treatment success.Material and Methods: Between January 2008 and January 2018, 495 children under 16 years of age who were treated with SWLusing ultrasonic and fluoroscopic focusing were included in the study. Patients with fluoroscopic focus were classified as Group1 and patients with ultrasonic focus were classified as Group 2. Demographic data, SWL parameters and success rates of the twogroups were compared..Results: There was no significant difference between the demographic data, stone localization and stone sizes of the groups. SWLsuccess rate was 90.5% in group 1 and 92.3% in group 2. There was no significant difference between the two groups in terms ofsuccess (p = 0.474). Complication rates were 0.2% (1 patient) and 0.4% (2 patients) in groups 1 and 2, respectively, and there wasno statistically significant difference (p = 0.495). With increasing clinical experience, ultrasonic focusing rates have increased andfluoroscopic focusing rates have decreased over the years.Conclusion: In the pediatric age group, we recommend the use of ultrasonic focusing with the additional advantage of avoidingradiation, avoiding the fluoroscopic focusing method using ionized radiation for SWL. We believe that randomized prospectivestudies will be more informative and support our study