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Extracorporeal shock-wave lithotripsy for treatment of ureteral calculi in paediatric patients
M Ozgür Tan1, Ustünol Karaoğlan, Sinan Sözen
1mozgurtan@yahoo.com
Insights
Extracorporeal shock wave lithotripsy (ESWL) is effective for pediatric ureteral stones, achieving an 81.6% stone-free rate. This less invasive treatment offers a high success rate as a first-line therapy for children.
Area of Science:
- Pediatric Urology
- Nephrology
- Surgical Innovation
Background:
- Ureteral stones in children present unique treatment challenges.
- Minimally invasive techniques are preferred for pediatric patients.
- Extracorporeal shock wave lithotripsy (ESWL) offers a non-invasive approach.
Purpose of the Study:
- To evaluate the efficacy and safety of ESWL for pediatric ureteral stones.
- To compare ESWL outcomes with other treatment modalities in children.
- To establish ESWL as a viable first-line therapy for pediatric ureteral calculous disease.
Main Methods:
- Retrospective review of 41 pediatric patients (4-16 years) treated for ureteral calculi between 1989-2001.
- Initial treatment with ESWL in 92.7% of cases; ureterolithotomy in 7.3%.
- Analysis of stone burden, shock wave parameters, complications, and stone-free rates.
Main Results:
- The overall stone-free rate after ESWL was 81.6%.
- Minor complications included skin ecchymosis and transient renal colic.
- Failure rate was 13.2%, with subsequent treatments including ureterolithotomy and ureteroscopy.
Conclusions:
- ESWL is a safe and effective first-line treatment for pediatric ureteral stones.
- It demonstrates a high success rate and is less invasive than ureteroscopy.
- ESWL offers a favorable option for managing pediatric ureteral calculous disease.
Abstract:
Our objective was to determine the efficacy of extracorporeal shock wave lithotripsy (ESWL) in the treatment of paediatric ureteral calculous disease. We reviewed the records of 41 (23 boys, 18 girls) paediatric patients admitted to our clinic for the treatment of ureteral calculi between between 1989-2001. Patients' age varied between 4-16 years. The majority of the patients, 38 (92.7%) cases were treated initially with ESWL whereas 3 (7.3%) cases were subjected to ureterolithotomy. The mean age of the patients was found as 12.8+/-3.86 (4-16) years. Most calculi were located at either upper or lower ureter. The mean stone burden was 45.16+/-30.65 mm2 and the mean shock wave number per session and power as 2826.72+/-605.18 and 17.69+/-1.11 kV respectively. Minor complications included skin ecchymosis at the site of entry of shock waves in all cases and renal colic that responded to analgesics and emetics in 3 (7.9%) patients. The overall stone-free rate after ESWL was found to be 81.6%. Two (5.3%) cases have residual fragments that escaped to lower calices after lithotripsy for upper ureteral calculi and are still followed. There were 5 (13.2%) failures who were treated with ureterolitotomy for 1 upper and 1 lower ureteral calculi and with ureteroscopy for the rest. It appears that ESWL is still a good option for the initial treatment of most ureteral calculi in children as it is less invasive than ureteroscopy and has a high success rate as a first-line therapy.
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