ArticleFrontiers in pediatrics2026
Optimizing pediatric shock wave lithotripsy: stepwise energy escalation vs. conventional fixed energy.
Article in Frontiers in pediatrics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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5 authors.
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Abstract
Background: Pediatric extracorporeal shock wave lithotripsy (ESWL) is widely used, but the optimal energy-delivery strategy remains uncertain. Adult data suggest that stepwise energy escalation may enhance fragmentation and limit tissue injury; pediatric evidence is limited. Methods: We conducted a single-center retrospective cohort of 81 children treated with ESWL using either a stepwise energy protocol ( Results: After the first session, stone-free status was observed in 73.2% (30/41) with the stepwise protocol vs. 55.0% (22/40) with the conventional protocol. At 3 months, rates were 95.1% (39/41) vs. 87.5% (35/40). When fragments ≤3 mm were considered clearance, overall rates were 97.6% (40/41) vs. 95.0% (38/40). More children achieved clearance in a single session with the stepwise protocol (30 vs. 22). Auxiliary ureteroscopy was required in 1 vs. 2 cases. Only minor, self-limited events (hematuria, transient pain/colic) were reported. Conclusion: Stepwise energy escalation was associated with numerically higher clearance and fewer sessions than fixed-energy ESWL, without added morbidity. Prospective multicenter studies are needed to confirm these findings.
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