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[Extracorporeal lithotripsy of upper urinary tract stones in children]
Mohamed Arifi1, Younès Halim, Mohammed el Amine Bouhafs
1Service d'Urologie Pédiatrique, Hôpital d'Enfants, Rabat, Maroc. drarifimohamed@yahoo.fr
Insights
Extracorporeal lithotripsy effectively treats urinary stones in children, including very young ones. This non-invasive procedure offers a safe and successful first-line treatment option for pediatric kidney and ureteric stones.
Area of Science:
- Pediatric Urology
- Nephrology
- Minimally Invasive Surgery
Background:
- Urinary stones in children present a significant clinical challenge.
- Effective and safe treatment options are crucial for pediatric patients.
- Extracorporeal lithotripsy has emerged as a potential solution for pediatric urolithiasis.
Purpose of the Study:
- To assess the efficacy of extracorporeal lithotripsy (ECL) for treating urinary stones in pediatric patients.
- To determine the success rate and safety profile of ECL in children of various age groups.
- To establish ECL as a primary treatment modality for pediatric urolithiasis.
Main Methods:
- A cohort of 34 children (aged 3-15 years) with symptomatic urinary stones were treated.
- A Lithostar Multiline lithotriptor was utilized, adapted for both adult and pediatric use.
- Children under 6 years received ketamine sedation; all patients had normal pre-treatment parameters.
Main Results:
- Treatment involved 1-3 sessions for 38 stones (30 renal, 8 ureteric).
- Post-treatment ultrasound at 3 months showed no fragments in 30 patients.
- Follow-up ultrasounds revealed no lesions of treated kidneys or adjacent organs.
Conclusions:
- Extracorporeal lithotripsy demonstrates high efficacy in treating pediatric urinary stones, including large and staghorn calculi.
- The procedure is safe and well-tolerated in children, even the very young.
- Extracorporeal lithotripsy is recommended as the first-line treatment for urinary stones in children.
Objective:
The objective of this study was to evaluate the efficacy of extracorporeal lithotripsy for the treatment of urinary stones in children.
Material And Methods:
From November 2002 to November 2004, 34 children from the department of paediatric urology of Rabat children's hospital, aged 3 to 15 years (mean age: 6 years), including 15 children under the age of 6 years, were treated for symptomatic urinary stones in the extracorporeal lithotripsy centre with a Lithostar Multiline lithotriptor adapted to the treatment of adults as well as children, even very young children. At the time of treatment, all 34 children had normal blood pressure, normal blood urea and creatinine, normal clotting parameters, sterile urine and no urinary tract obstruction. All children under the age of 6 years were treated under ketamine sedation.
Results:
Treatment required a variable number of sessions from 1 to 3 (mean: 1.5) and concerned 38 stones: 30 renal stones including 6 staghorn and 8 ureteric stones. The number of impacts delivered per session ranged from 1,500 to 3,500 for renal stones (mean: 2,500 impacts), with a maximum of 5,000 impacts for ureteric stones (mean: 3,250 impacts). Three months after the last lithotripsy session, 30 patients presented no fragments. No lesion of the treated kidney or adjacent organs was demonstrated on follow-up ultrasound performed 3 to 6 months after treatment.
Conclusion:
Evaluation of the results confirms the efficacy of extracorporeal lithotripsy for the treatment of even very large urinary stones in children, even in very young children. Extracorporeal lithotripsy is now the first-line treatment for-urinary stones in children.
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