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Staghorn calculi in children: treatment with monotherapy extracorporeal shock wave lithotripsy
A Orsola1, I Diaz, J Caffaratti
1Uropediatric and Radiology Units, Fundació Puigvert, Barcelona, Spain.
Insights
Extracorporeal shock wave lithotripsy (ESWL) effectively treated pediatric staghorn calculi in 73.3% of cases. This minimally invasive treatment offers a safe and simple primary option for children requiring kidney stone removal.
Area of Science:
- Pediatric Urology
- Nephrolithiasis Treatment
- Extracorporeal Shock Wave Lithotripsy
Background:
- Staghorn calculi present a significant challenge in pediatric urology.
- Effective and minimally invasive treatment options are crucial for pediatric patients.
Purpose of the Study:
- To evaluate the efficacy of monotherapy extracorporeal shock wave lithotripsy (ESWL) for pediatric staghorn calculi.
- To assess the safety and simplicity of ESWL as a primary treatment modality.
Main Methods:
- ESWL was performed on 15 children (14 months to 13 years) with staghorn calculi.
- A Siemens Lithostar-ULTRA device was used with ultrasound guidance and progressive shock wave delivery.
- Procedures were conducted with intravenous sedation or no anesthesia, employing the Puigvert method for pain reduction.
Main Results:
- Successful stone resolution was achieved in 11 of 15 patients (73.3%) after an average of 2 ESWL sessions.
- Seven patients were stone-free after one session; two required no further intervention for residual fragments.
- Two patients needed additional surgery for residual fragments or a cystine calculus; no ureteral stents were required.
Conclusions:
- Monotherapy ESWL using the Siemens Lithostar-ULTRA is a simple, effective, and safe primary treatment for pediatric staghorn calculi.
- The Puigvert method enhances patient comfort and treatment effectiveness.
- ESWL demonstrates a favorable outcome profile in the pediatric population.
Purpose:
We evaluated the effectiveness of monotherapy extracorporeal shock wave lithotripsy (ESWLT) for treating children with staghorn calculi.
Materials And Methods:
From February 1992 to December 1997, 11 boys and 4 girls 14 months to 13 years old (median age 4 years) presented to our institution with staghorn calculi. In these patients ESWL was performed using a Siemens Lithostar-ULTRA with ultrasound stone localization and with intravenous sedation or without anesthesia. Using the Puigvert method the frequency and energy of the shock waves delivered were increased progressively to desensitize cutaneous nerve receptors, making the procedure less painful and improving stone fragmentation.
Results:
Overall stones resolved in 11 of the 15 patients (73.3%) after an average of 2 ESWL sessions. Of the 11 patients 7 were stone-free after only 1 session, 2 with fragments less than 5 mm. required no further intervention, and 2 required additional surgery, including percutaneous nephrolithotomy to remove large residual stone fragments in 1 and open renal surgery to remove a cystine staghorn calculus in 1. Ureteral stents were not required in any patients. One case of post-ESWL fever resolved promptly with antibiotics.
Conclusions:
ESWL using the Siemens Lithostar-ULTRA is simple, effective and safe primary treatment in children with staghorn calculi.