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Purpose: Shockwave lithotripsy (SWL) is a minimally invasive technique utilized for renal and ureteric stones in children. Despite being considered safe, certain complications have been recorded. We performed this systematic review and meta-analysis to provide a pooled analysis of Clavien–Dindo graded complications after SWL in children. Methods: MEDLINE/PubMed, Scopus and Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews, were screened from inception to 12/02/2022 by two authors independently. Only randomized controlled trials providing Clavien–Dindo classification or relevant clinical information were considered eligible. Overall complications were calculated using the aggregate number of each complication divided by the total number of patients in studies with data. Results: Pooled analysis revealed that from children treated with SWL, 27.7% [95% CI 13.1–49.4] suffered Clavien I complications, 4.9% [95% CI 3.1–7.6] Clavien II complications, 2.7% [95% CI 1.6–4.7] Clavien III complications, 2.3% [95% CI 1.3–4] Clavien IV complications, while no Clavien V complications were recorded. In total, 28.1% [95% CI 15.6–45.3] of children suffered minor complications (Clavien–Dindo I–II), while 3% [95% CI 1.8–5] major complications (Clavien–Dindo III–V). Pooled analysis revealed that 10.7% [95% CI 3.2–30.1] of patients suffered macroscopic hematuria, 7.3% [95% CI 2.1–22.7] pain, 5.5% [95% CI 3.3–9] steinstrasse, 5.3% [95% CI 3–9.3] fever, 2.2% [95% CI 0.8–5.6] sepsis, 1.1% [95% CI 0.3–3.7] urinoma, 1% [95% CI 0.4–2.7] symptomatic hematoma and 1% [95% CI 0.3–2.7] asymptomatic hematoma. Need for re-treatment was 42.6% [95% CI 31.4–54.7] and need for auxiliary procedures was 11.8% [95% CI 8.5–16.1]. Conclusion: SWL is an irreplaceable tool for treating urolithiasis in children. Although a minimally invasive technique, parents and children should be adequately informed about the risk of minor/major complications. [ABSTRACT FROM AUTHOR]

Shock wave lithotripsy (SWL): outcomes from a national SWL database in New Zealand. Keywords: Ureterorenoscopy; Urolithiasis; Extracorporeal shock wave lithotripsy; Education EN Ureterorenoscopy Urolithiasis Extracorporeal shock wave lithotripsy Education 1265 1266 2 05/11/22 20220501 NES 220501 This comment refers to the article available online at https://doi.org/10.1007/s00345-021-03818-y. [Extracted from the article]