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Published on: December 23, 2022
Extracorporeal shock wave lithotripsy is highly effective for ureteral calculi in children
E H Landau1, O N Gofrit, A Shapiro
1Department of Urology, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
Insights
Extracorporeal shock wave lithotripsy (ESWL) is a safe and effective treatment for pediatric ureteral stones. This study shows a high stone-free rate with ESWL monotherapy in children.
Area of Science:
- Pediatric Urology
- Nephrology
- Endourology
Background:
- Pediatric ureteral calculi present unique treatment challenges.
- Extracorporeal shock wave lithotripsy (ESWL) and ureteroscopy are common treatment options.
Purpose of the Study:
- To evaluate the efficacy and safety of ESWL monotherapy for pediatric ureteral stones.
- To analyze outcomes based on stone size, location, and patient demographics.
Main Methods:
- Retrospective review of 38 pediatric patients (1989-1999) treated with ESWL monotherapy.
- Analysis of stone characteristics, treatment sessions, outcomes, and complications.
- Use of general anesthesia, with ureteral catheters in 15 patients and nephrostomies in 3.
Main Results:
- Overall success rate of 97.3% with ESWL.
- 81.5% of patients were stone-free after one session; 94.6% after two.
- 100% stone-free rate for stones ≤10 mm; 67% for stones >10 mm after one session.
- No postoperative urinary infections or ureteral obstructions reported.
Conclusions:
- ESWL monotherapy is an efficient and safe treatment modality for pediatric ureteral stones.
- ESWL demonstrates high success rates, particularly for smaller stones.
- The procedure is well-tolerated with minimal complications in the pediatric population.
Purpose:
Treatment of ureteral calculi in the pediatric population represents a unique challenge. Extracorporeal shock wave lithotripsy (ESWL*) and ureteroscopy have been advocated for the treatment of such stones. We present our experience with ESWL monotherapy for ureteral stones in children in the last decade.
Materials And Methods:
Between 1989 and 1999 we treated 21 boys and 17 girls with a mean age of 8 years (range 8 months to 14 years) with ureteral stones at our institution. Records were reviewed and analyzed for presentation, metabolic and anatomical anomalies, stone size and location, outcome and complications. Average stone size was 9.5 x 6.5 mm. (range 3 to 32). Stones were in the upper ureter in 17 cases, mid ureter in 2 and lower ureter in 19. All patients underwent ESWL with a Dornier HM3 lithotriptor under general anesthesia. Nephrostomies were placed in an anuric infant with bilateral ureteral obstruction and in 2 patients with nonfunctioning kidneys (4 renal units). Ureteral catheters were used in 15 patients for better identification and localization of the stone during ESWL. The catheters were removed immediately postoperatively.
Results:
Of the patients 31 (81.5%) were free of stones after 1 session of ESWL, 5 (13.1%) after 2 and 1 after 3. One patient underwent ureteroscopy for residual fragments after 2 ESWL sessions. The stone-free rate following 1 ESWL session was 100% for ureteral calculi 10 mm. or smaller regardless of location. Of the 12 patients with stones larger than 10 mm. 8 (67%) were free of stones following 1 ESWL session. The overall success rate of ESWL was 97.3%. No child had postoperative urinary infection or ureteral obstruction.
Conclusions:
ESWL is an efficient and safe modality for the treatment of pediatric ureteral stones.
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