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Extracorporeal shock wave lithotripsy in children
Nelson Rodrigues Netto1, José Antonio Longo, Jean A Ikonomidis
1Department of Urology, Hospital Israelita Albert Einstein, São Paulo, Brazil.
Insights
Extracorporeal shock wave lithotripsy (ESWL) effectively treats pediatric urinary stones. This noninvasive method achieved high stone-free rates in children, demonstrating its efficacy for various stone types.
Area of Science:
- Pediatric Urology
- Nephrolithiasis Treatment
- Minimally Invasive Surgery
Background:
- This study evaluated the efficacy of extracorporeal shock wave lithotripsy (ESWL) in pediatric patients with urinary calculi.
- The Siemens Lithostar Plus device was used for treatment between 1987 and 2000.
Discussion:
- ESWL demonstrated a high success rate for complete stone fragment removal in children.
- The procedure was performed on an outpatient basis with varying levels of sedation or anesthesia.
- Complications were minimal and managed effectively with medical treatment.
Key Insights:
- Complete stone removal was achieved in 97.6% of pediatric cases after 3 months.
- Re-treatment was required in 27.9% of patients.
- ESWL proved effective for both radiopaque and radiolucent urinary calculi in children.
Outlook:
- ESWL is a viable, noninvasive option for pediatric urinary stone management.
- Further research could explore long-term outcomes and optimal anesthetic protocols.
- The Lithostar Plus system offers a safe and effective treatment modality for pediatric nephrolithiasis.
Purpose:
We analyzed the efficacy of extracorporeal shock wave lithotripsy in children.
Materials And Methods:
Between 1987 and 2000, 15,423 patients with urinary calculi were treated at our institution, of whom 86 (0.56%) children 3 to 14 years old underwent lithotripsy using the Siemens Lithostar Plus (Siemens Medical Systems, Iselin, New Jersey). A total of 121 calculi in 90 urinary tracts were treated requiring 149 extracorporeal shock wave lithotripsy sessions. The stones were caliceal in 62 cases, renal pelvic in 35, ureteral in 18 and staghorn in 6. Followup consisted of nephrotomogram or ultrasound 1 day and 1 to 3 months postoperatively.
Results:
Complete removal of all stone fragments was achieved in 97.6% of the stones after 3 months. Re-treatment was necessary in 24 patients (27.9%). All patients were treated as outpatients with intravenous sedation in 54 (62.8%), general anesthesia in 13 (15.1%) and no anesthesia in 19 (22.1%). Complications were present in 8 patients (10.7%) who had colic and received medical treatment followed by uneventful recovery.
Conclusions:
Extracorporeal shock wave lithotripsy using the Lithostar Plus has been demonstrated to be an effective noninvasive procedure to treat radiopaque and even radiolucent or slightly opaque urinary calculi in children.
