Extracorporeal Shock Wave Lithotripsy (ESWL) remains a cornerstone non-invasive modality for managing pediatric urolithiasis, leveraging focused acoustic energy to fragment calculi. This study evaluates the efficacy and predictive utility of the Dogan and Onal scoring systems in a 15-year cohort of 326 pediatric patients, contextualized within contemporary AUA and EAU recommendations for optimizing ESWL outcomes.

Between 2009 and 2024, 326 children (aged 1-18 years) underwent ESWL using a third-generation Hydroelectric lithotripter, delivering 2000-3000 shock waves per session at 65 pulses per minute. Stone localization was achieved via ultrasonography. Dogan and Onal scores were derived from stone characteristics (size, location) and patient variables (age, BMI, skin-to-stone distance). Treatment success was defined as stone-free status or residual fragments <4mm at 3 months post-procedure, per EAU criteria; failure encompassed residuals ≥4mm or the need for auxiliary interventions. Statistical analysis employed logistic regression to assess score-outcome associations, with receiver operating characteristic (ROC) curves quantifying predictive accuracy.

The cohort had a mean age of 9.7 years, with 58% male patients (n=189/326). Calculi distribution included renal pelvis (45%), proximal ureter (30%), and other sites (25%). The stone-free rate was 72% (n=235/326), with 18% (n=59/326) exhibiting clinically insignificant residuals and 10% (n=32/326) classified as failures—consistent with AUA-reported efficacy rates of 70-90% for stones <20mm. Stratified by Dogan score, patients with scores <2 achieved an 85% success rate (111/130), declining to 45% (15/33) for scores >4. For Onal scores, success was 82% (161/196) at <3, dropping to 25% (8/32) at >5. Logistic regression confirmed significant predictive power for both Dogan (odds ratio [OR]=0.72, 95% CI 0.65-0.80, P<0.001) and Onal (OR=0.68, 95% CI 0.61-0.76, P<0.001) scores. ROC analysis yielded an area under the curve (AUC) values of 0.78 for Dogan and 0.75 for Onal, with no statistically significant difference in discriminatory capacity (P=0.23), aligning with predictive models in recent literature.

ESWL demonstrates robust efficacy in pediatric urolithiasis, with a 72% stone-free rate corroborated by contemporary AUA/EAU benchmarks. The Dogan and Onal scoring systems offer reliable preoperative prognostication, with lower scores portending superior outcomes. Comparable AUCs (0.78 and 0.75) underscore their utility as validated tools. Adherence to optimized protocols—such as reduced shock wave frequency and enhanced targeting—may further elevate success rates, supporting their integration into clinical decision-making for pediatric stone management.