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The efficacy and parenchymal consequences of extracorporeal shock wave lithotripsy in infants
H B Lottmann1, F Archambaud, O Traxer
1Departments of Paediatric Urology and Radiology, Fondation Hôpital Saint Joseph, Paris, France. uro.inf@worldnet.fr
Insights
Extracorporeal shock-wave lithotripsy (ESWL) effectively treats kidney stones in infants, with no observed adverse effects on renal parenchyma. Follow-up assessments confirmed treatment safety and efficacy in young children.
Area of Science:
- Pediatric Urology
- Nephrology
- Medical Imaging
Background:
- Infant urolithiasis presents unique treatment challenges.
- Assessing the safety and efficacy of extracorporeal shock-wave lithotripsy (ESWL) in this population is crucial.
Purpose of the Study:
- To evaluate the effectiveness of ESWL for kidney stones in infants (5-24 months).
- To assess potential adverse effects on renal parenchyma using renal scintigraphy.
Main Methods:
- Nineteen infants with kidney urolithiasis underwent ESWL.
- Evaluations included physical exams, conventional imaging, and renal scintigraphy pre- and post-treatment (≥6 months).
Main Results:
- Stone-free status achieved in 10/19 after one ESWL session and 18/19 after two.
- No hypertension or acquired parenchymal damage detected on imaging.
- Renal scintigraphy showed no ESWL-attributable scars or significant functional variations.
Conclusions:
- ESWL is a safe and effective treatment for infant urolithiasis.
- No renal parenchymal lesions were associated with ESWL, even in complex cases.
- Long-term follow-up and pre/post-ESWL renal scintigraphy are recommended.
Objectives:
To determine the efficacy of extracorporeal shock-wave lithotripsy (ESWL) in young children and to evaluate, using renal scintigraphy, any possible adverse effects on renal parenchyma.
Patients And Methods:
From January 1991 to October 1998, 19 infants (aged 5-24 months) underwent ESWL for kidney urolithiasis using a Sonolith 3000 (14 kV, Technomed Corp, Lyon, France) or a Nova (14-20 kV, Direx Medical Systems, Paris, France) lithotripter. The treatment and its effects were evaluated using a physical examination, conventional imaging (plain abdominal X-ray and ultrasonography) and renal scintigraphy 24 h before ESWL and again at least 6 months after the last session of treatment.
Results:
Ten children were rendered stone-free by ESWL after one session and 18 after two sessions. At the follow-up (8 months to 8 years, mean 36 months) no hypertension was recorded and no acquired parenchymal damage was detected with conventional imaging. No scars or significant variation of differential function attributable to ESWL were identified on renal scintigraphy.
Conclusion:
ESWL is clearly effective for treating infant urolithiasis. There were no renal parenchymal lesions associated with ESWL, even in previously damaged kidneys or after the treatment of staghorn calculi. A long-term follow-up (assessing blood pressure) is mandatory and renal scintigraphy before and 6 months after ESWL in infants is recommended to confirm these results in a larger series.