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Ungated extracorporeal shock wave lithotripsy in children: an initial series
Katherine Rhee1, Jeffrey S Palmer
1Division of Pediatric Urology, Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
Insights
Ungated extracorporeal shock wave lithotripsy (ESWL) is safe and effective for pediatric kidney stones. This study found no cardiac arrhythmias or complications in children undergoing this procedure.
Area of Science:
- Pediatric Urology
- Nephrolithiasis Treatment
- Extracorporeal Shock Wave Lithotripsy
Background:
- Ungated extracorporeal shock wave lithotripsy (ESWL) is linked to cardiac arrhythmias in adults.
- The safety of ungated ESWL in pediatric patients remains unestablished.
Purpose of the Study:
- To evaluate the safety and efficacy of ungated ESWL for treating renal calculi in children.
- To determine the incidence of arrhythmias during ungated ESWL in pediatric patients.
Main Methods:
- Retrospective evaluation of pediatric patients (<18 years) undergoing ungated ESWL for renal calculi.
- Continuous cardiac monitoring by anesthesiologists for arrhythmias and other intraoperative complications.
Main Results:
- Ten ESWL procedures were performed on eight pediatric patients (ages 3.5-17 years).
- No cardiac arrhythmias or intraoperative complications were observed in any patient.
- The overall stone-free rate was 90.0%.
Conclusions:
- Ungated ESWL appears to be a safe and effective treatment option for pediatric renal calculi.
- Further research is recommended to confirm these findings in a larger pediatric cohort.
Objectives:
Ungated extracorporeal shock wave lithotripsy (ESWL) is associated with cardiac arrhythmias in adults. However, the incidence of arrhythmias in children undergoing ungated ESWL has not been established. Therefore, we report on the safety and efficacy of ungated ESWL of renal calculi in children.
Methods:
We evaluated all patients younger than 18 years of age who were undergoing ungated ESWL of renal calculi. All patients were monitored for arrhythmias, along with other standard monitoring, by the anesthesiologist.
Results:
Eight consecutive children (three boys and five girls) between 3.5 and 17 years of age (median 13.5) underwent 10 ESWL procedures for renal calculi. Of the 10 stones, 9 were located in the left kidney and 1 was located in the right kidney. The stone size ranged from 5 to 19 mm. Six patients underwent 3000 shocks and 2 patients underwent 800 and 2200 shocks. All patients underwent lithotripsy with a gradual incremental energy increase from 17 to 24 kV, except for 1 child (maximum of 18 kV) because of the patient's age (3.5 years). No patient had cardiac arrhythmias or other intraoperative complications. No patient required conversion to gated ESWL. The overall stone-free rate was 90.0% as determined by abdominal radiography and renal/bladder ultrasonography.
Conclusions:
The results of this initial series suggest that ungated ESWL is safe and efficacious in patients younger than 18 years of age. Additional studies are warranted to evaluate further the use of ungated ESWL in the pediatric population.
