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[Extracorporeal lithotripsy in children. Report of 30 cases]
Anouar Krichene1, Eric Fontaine, Vincent Quenneville
1Service de Chirurgie Urologique, Hôpital Ambroise Paré, 9, avenue Charles de Gaulle, 92110 Boulogne, France.
Insights
Extracorporeal lithotripsy is an effective treatment for pediatric urinary stones, achieving a 77% success rate. This method is recommended as a primary treatment option for children, with untreated obstructive uropathy as the main contraindication.
Area of Science:
- Pediatric Urology
- Nephrolithiasis Management
- Minimally Invasive Surgery
Context:
- Urinary stones in children present unique management challenges.
- Traditional treatments may have limitations in pediatric populations.
- Evaluating novel and effective treatment modalities is crucial.
Purpose:
- To assess the effectiveness of extracorporeal lithotripsy (ECL) for treating urinary stones in pediatric patients.
- To determine the success rate and complication profile of ECL in this demographic.
- To establish ECL as a potential first-line therapy for pediatric urolithiasis.
Summary:
- Extracorporeal lithotripsy was performed on 30 children (32 stones), with stones located in the kidney (27) and ureter (5).
- The overall success rate, defined as the absence of residual fragments, was 77% after a mean of 1.3 sessions.
- Complications were infrequent, including ureteric obstruction and anuria, managed with interventions like double J stenting and nephrostomy.
Impact:
- Extracorporeal lithotripsy demonstrates significant efficacy in pediatric urinary stone treatment.
- The findings support considering ECL as a primary therapeutic option for children with urolithiasis.
- Identifying untreated obstructive uropathy as the sole contraindication aids in patient selection.
Objective:
To evaluate the efficacy of extracorporeal lithotripsy in the treatment of urinary stones in children.
Material And Method:
Thirty children (19 boys, 11 girls) with a mean age of 7 years (range: 14 months to 17 years) with a total of 32 urinary stones were treated by extracorporeal lithotripsy. The stone was situated in the kidney in 27 cases, the lumbar ureter in 4 cases and the pelvic ureter in 1 case. 19 patients had single stones, 9 patients had multiple pyelocaliceal stones and 3 had staghorn calculi.
Results:
General anaesthesia was performed in 2/3 of cases (age < 10 years). The mean number of treatment sessions was 1.3. The success rate (absence of residual fragments) was 77%, while residual fragments < or = 3 mm persisted in 4 cases. There were 3 failures. Complications occurred in 3 cases: ureteric obstruction (2), anuria (1) requiring complementary treatment: double J stent (1), nephrostomy (1), incision of ureterocele (1).
Conclusion:
Extracorporeal lithotripsy is effective in children and must be considered as first-line treatment for urinary stones in children. The only contraindication is untreated obstructive uropathy.