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[Extracorporeal lithotripsy for the treatment of urolithiasis in children]
Ricardo J Duarte1, Anuar I Mitre, Francisco T Dénes
1Divisão de Clínica Urológica, Hospital das Clínicas, Universidade de Sáo Paulo, Sáo Paulo, SP.
Insights
Extracorporeal shockwave lithotripsy (ESWL) is a safe and effective treatment for pediatric urinary stones, with high success rates for pelvic, caliceal, ureteral, and bladder calculi. However, staghorn calculi showed limited success with ESWL.
Area of Science:
- Pediatric Urology
- Minimally Invasive Surgery
- Nephrolithiasis Treatment
Context:
- Urinary lithiasis impacts 5-10% of the population, with children representing 2-3%.
- Minimally invasive therapies offer an attractive alternative for pediatric urolithiasis.
- Extracorporeal shockwave lithotripsy (ESWL) is a key minimally invasive option.
Purpose:
- To evaluate the efficacy and safety of ESWL for treating urinary lithiasis in children.
- To analyze ESWL outcomes based on stone location and type in the pediatric population.
Summary:
- This study assessed 93 urinary calculi in 87 children treated with ESWL using the Dornier-Philips lithotriptor between 1991 and 2000.
- Successful fragmentation and elimination rates varied by stone location: 87.7% for pelvic, 77.8% for superior/medium caliceal, 64.7% for inferior caliceal, and 100% for ureteral stones.
- Staghorn calculi had a low success rate (33.3%), and bladder stones were eliminated in 60% of cases.
Impact:
- ESWL is a safe and effective treatment for most pediatric urinary stones, particularly pelvic, caliceal, ureteral, and bladder calculi.
- Stone location and size significantly influence ESWL outcomes in children.
- ESWL is not ideal for staghorn calculi in the pediatric population, suggesting alternative treatment considerations.
Objective:
Urinary lithiasis affects between five and 10% of the human population during their lifetime, only 2-3% of whom are children. Therapy of urolithiasis in the pediatric age group with minimally invasive methodology represents an attractive alternative. This study presents results of extracorporeal shockwave lithotripsy, a minimally invasive methodology, for the treatment of urinary lithiasis in children.
Methods:
In the period between September 1991 and September 2000, 87 children were submitted to extracorporeal shockwave lithotripsy; as six of them presented with two calculi 93 urinary calculi were treated over that period. The Dornier-Philips lithotriptor was used in the procedures.
Results:
Pelvic, superior and medium caliceal calculi were fragmented and eliminated in 87.7% and 77.8% of cases, respectively. Inferior caliceal stones were eliminated in 64.7% of cases. Only one of the three patients with staghorn calculi became stone-free after therapy (33.3%). All patients with ureteral calculi were stone-free after therapy. Bladder stones were fragmented and eliminated in 60% of cases.
Conclusions:
Extracorporeal shockwave lithotripsy is a safe and effective treatment for pelvic, caliceal, ureteral and bladder urolithiasis in children. Staghorn calculi have not shown satisfactory results when treated by this method. Extracorporeal shockwave lithotripsy results were influenced in our experience by the position and size of the treated calculi.
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