title: A multicenter, randomized, controlled trial of transureteral and shock wave lithotripsy--which is the best minimally invasive modality to treat distal ureteral calculi in children?
abstract: OBJECTIVE
  Since there is insufficient evidence to determine the best treatment modality in children with distal ureteral calculi, we designed a multicenter, randomized, controlled trial to evaluate the efficacy and complications of transureteral and shock wave lithotripsy in these patients.
  
  
  METHODS
  A total of 100 children with distal ureteral calculi were included in the study. Of the patients 50 were randomized consecutively to undergo shock wave lithotripsy using a Compact Delta II lithotriptor (Dornier MedTech, Kennesaw, Georgia), and 50 were randomized to undergo transureteral lithotripsy with holmium laser and pneumatic lithotriptor between February 2007 and October 2009. Stone-free, complication and efficiency quotient rates were assessed in each group.
  
  
  RESULTS
  Mean +/- SD patient age was 6.5 +/- 3.7 years (range 1 to 13). Mean stone surface was 35 mm(2) in the transureteral group and 37 mm(2) in the shock wave lithotripsy group. Stone-free rates at 2 weeks after transureteral lithotripsy and single session shock wave lithotripsy differed significantly, at 78% and 56%, respectively (p = 0.004). With 2 sessions of shock wave lithotripsy the stone-free rate increased to 72%. Efficiency quotient was significantly higher for transureteral vs shock wave lithotripsy (81% vs 62%, p = 0.001). Minor complications were comparable and negligible between the groups. Two patients (4%) who underwent transureteral lithotripsy sustained a ureteral perforation.
  
  
  CONCLUSIONS
  In the short term it seems that transureteral and shock wave lithotripsy are acceptable modalities for the treatment of distal ureteral calculi in children. However, transureteral lithotripsy has a higher efficacy rate when performed meticulously by experienced hands using appropriate instruments.
authors.affiliation: Urology and Nephrology Research Center (UNRC), Shahid Labbafinejad Medical Center, Shahid Beheshti University, M. C. (SBMU), Tehran, I. R. Iran. basiri@unrc.ir
authors.forename: Abbas
authors.initials: A
authors.lastname: Basiri
authors.forename: Samad
authors.initials: S
authors.lastname: Zare
authors.forename: Ali
authors.initials: A
authors.lastname: Tabibi
authors.forename: Farzaneh
authors.initials: F
authors.lastname: Sharifiaghdas
authors.forename: Alireza
authors.initials: A
authors.lastname: Aminsharifi
authors.forename: Seyed Habibollah
authors.initials: SH
authors.lastname: Mousavi-Bahar
authors.forename: Hassan
authors.initials: H
authors.lastname: Ahmadnia
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008096:Lithotripsy / Q000379:methods*; D008297:Male; D011446:Prospective Studies; D014513:Ureter; D014514:Ureteral Calculi / Q000473:pathology / Q000628:therapy*