Related Experiment Videos
Extracorporeal shock wave lithotripsy for cystine urolithiasis in children: outcome and complications
Andjelka Slavković1, Miladin Radovanović, Zlatko Sirić
1Clinic for Pediatric Surgery, Clinical Center, Nis, Yugoslavia.
Insights
Extracorporeal shock wave lithotripsy (ESWL) showed a 50% stone-free rate in children with cystine stones. ESWL was effective for pelvic and ureteral stones but less successful for caliceal stones.
Area of Science:
- Pediatric Urology
- Nephrolithiasis Treatment
- Extracorporeal Shock Wave Lithotripsy
Background:
- Cystine nephrolithiasis presents a treatment challenge, particularly in pediatric patients.
- Previous open surgery may impact treatment outcomes for kidney stones.
- Extracorporeal shock wave lithotripsy (ESWL) is a non-invasive option for stone management.
Purpose of the Study:
- To evaluate the efficacy and safety of ESWL in treating pediatric cystine nephrolithiasis.
- To determine factors influencing ESWL success rates in children with cystine stones.
- To assess the role of ESWL as an auxiliary procedure in combined treatment strategies.
Main Methods:
- Retrospective analysis of 6 pediatric patients with cystine nephrolithiasis treated with Siemens Lithostar Litotriptor.
- Patients received 1-4 ESWL sessions, with 1,800-12,000 shock waves per session.
- Stone location (renal pelvis, caliceal, ureteral) and prior surgical history were considered.
Main Results:
- A 50% stone-free rate was achieved at 3 months post-ESWL.
- Complete elimination of stones was observed in renal pelvis and ureteral locations.
- ESWL failed in caliceal stones, even after up to 4 treatment sessions.
- Stone location, not prior surgery, correlated with ESWL success.
- One patient experienced a resolving perirenal hematoma.
Conclusions:
- ESWL is a safe and effective auxiliary treatment for pediatric cystine stones located in the renal pelvis and ureter.
- ESWL demonstrated limited success for caliceal cystine stones.
- Medical dissolution is effective for managing residual stone fragments after ESWL.
Abstract:
The Siemens Lithostar Litotriptor was used to treat 6 children with cystine nephrolithiasis, previously treated by open surgery. Five children had renal calculi (3 multiple caliceal, 2 pelvis) and one had ureteral calculus. Stone size ranged from 0.2-2.5 cm in diameter, and stone burden was from 0.24 to 10.81 cm3 per kidney. From one to 4 ESWL sessions per unit were applied, with a total of 1,800 to 12,000 shock waves. The stone free rate at 3 months was 50%. A complete elimination was obtained with cystine stones in renal pelvis and ureter, however, up to 4 ESWL treatments failed in caliceal stones. Rather location of cystine calculi than previous surgery was associated with ESWL success rate. Two patients with positive urine cultures were successfully treated with appropriate antibiotics before ESWL was attempted. Perirenal hematoma was major complication demonstrated by radionuclide scintigraphy in one patient, and resolved spontaneously by 3 months. In the combined treatment of cystine urolithiasis in children ESWL, as auxillary procedure, was safe and effective in pelvis stone but failed in caliceal stones. Medical dissolution for retained fragments was found effective.
Related Concept Videos
01:25Urinary Tract Calculi VI: Surgical Management
01:30Urinary Tract Calculi III: Medical Management
01:28Urologic Endoscopic Procedure: Cystoscopic Examination
01:28Urinary Tract Calculi V: Nursing Management
01:28Urinary Tract Calculi I: Introduction
01:27Urinary Tract Calculi IV: Nutrition Therapy and Prevention