{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T06:54:18Z","timestamp":1774853658438,"version":"3.50.1"},"reference-count":31,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T00:00:00Z","timestamp":1774828800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We conducted a single-center retrospective cohort of 81 children treated with ESWL using either a stepwise energy protocol (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200941) or a conventional fixed-energy protocol (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200940). The stepwise protocol began at 10\u2005kV with 1\u2005kV increases every 250 shocks up to 13\u2005kV (maximum 3,000 shocks per session); the conventional protocol used a fixed 13\u2005kV. Primary outcome was 3-month stone-free status, defined as no visible stones on follow-up imaging, excluding fragments \u22643\u2005mm. Secondary outcomes included stone-free status after the first session, number of sessions, auxiliary procedures, and complications.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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 \u22643\u2005mm 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fped.2026.1736104","type":"journal-article","created":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T05:27:17Z","timestamp":1774848437000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Optimizing pediatric shock wave lithotripsy: stepwise energy escalation vs. conventional fixed energy"],"prefix":"10.3389","volume":"14","author":[{"given":"Mehmet Ali","family":"Erg\u00fcl","sequence":"first","affiliation":[{"name":"Department of Urology, Doha Clinic Hospital","place":["Doha, Qatar"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"\u0130brahim","family":"\u00dcntan","sequence":"additional","affiliation":[{"name":"Department of Urology, Ahi Evran University School of Medicine","place":["K\u0131r\u015fehir, T\u00fcrkiye"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sultan","family":"\u00dcntan","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, Atat\u00fcrk Sanatoryum Education and Research Hospital","place":["Ankara, T\u00fcrkiye"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ay\u015fe Bet\u00fcl","family":"Erg\u00fcl","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Muaither Health Center, Primary Health Care Corporation","place":["Doha, Qatar"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Deniz","family":"Demirci","sequence":"additional","affiliation":[{"name":"Department of Urology, Erciyes University School of Medicine","place":["Kayseri, T\u00fcrkiye"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,3,30]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1529407","DOI":"10.3389\/fped.2025.1529407","article-title":"The global, regional, and national burden of pediatric stone disease: 1990\u20132021 and projections for the next two decades","volume":"13","author":"Chen","year":"2025","journal-title":"Front Pediatr"},{"key":"B2","doi-asserted-by":"publisher","first-page":"8","DOI":"10.5222\/JTAPS.2013.008","article-title":"Urinary system stone disease in children","volume":"27","author":"\u00d6nen","year":"2013","journal-title":"Turk J Pediatr Surg"},{"key":"B3","doi-asserted-by":"publisher","first-page":"609664","DOI":"10.3389\/fped.2021.609664","article-title":"Extracorporeal shock wave lithotripsy and combined therapy in children: efficacy and long-term results","volume":"9","author":"Burgos Lucena","year":"2021","journal-title":"Front Pediatr"},{"key":"B4","doi-asserted-by":"publisher","first-page":"1063159","DOI":"10.3389\/fsurg.2023.1063159","article-title":"Which frequency is better for pediatric shock wave lithotripsy? 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