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Shock wave lithotripsy is effective and safe for distal ureteral calculi in children
Isa Ozbey1, Yilmaz Aksoy, Tevfik Ziypak
1Department of Urology School of Medicine, Ataturk University, 25240 Erzurum, Turkey.
Insights
Shock wave lithotripsy using the Siemens Lithostar Modularis effectively treated pediatric distal ureteral stones, achieving an 86.2% success rate with minimal complications. This method offers a safe and efficient option for pediatric urolithiasis management.
Area of Science:
- Pediatric Urology
- Nephrolithiasis Management
- Extracorporeal Shock Wave Lithotripsy (ESWL)
Background:
- Distal ureteric calculi in children present unique management challenges.
- Extracorporeal shock wave lithotripsy (ESWL) is a non-invasive treatment option for pediatric urolithiasis.
- Evaluating specific lithotriptor devices is crucial for optimizing pediatric stone treatment.
Purpose of the Study:
- To assess the effectiveness and safety of the Siemens Lithostar Modularis lithotriptor for treating distal ureteric calculi in pediatric patients.
- To determine key performance metrics including success rates, retreatment needs, and complication profiles.
Main Methods:
- A retrospective analysis of 29 children (age 1-13 years) treated for distal ureteric calculi between 2004-2006.
- Treatment involved the Siemens Lithostar Modularis under fluoroscopic guidance, with a maximum of 3,000 shocks.
- Outcomes assessed included stone-free rates at 3 months, retreatment rates, efficacy quotient, and complications.
Main Results:
- A high complete clearance rate of 86.2% was observed at 3 months post-treatment.
- The mean number of sessions was 1.5, with re-treatment and efficacy quotient rates of 41.4% and 55.6%, respectively.
- Complications were infrequent, with 6.9% experiencing significant issues (UTI, steinstrasse) and minor petechial hemorrhage noted in all patients.
Conclusions:
- The Siemens Lithostar Modularis demonstrates high efficacy and a favorable safety profile for managing distal ureteric calculi in children.
- ESWL with this device offers a successful treatment option for pediatric urolithiasis, characterized by a high stone-free rate and low complication incidence.
Abstract:
We evaluated the effectiveness of the Siemens Lithostar Modularis lithotriptor for the management of distal ureteric calculi in children. Between 2004 and 2006, 29 children with distal ureteric calculi were treated in our stone center with the Siemens Lithostar Modularis (Siemens Medical Solutions, Inc.) Effectiveness of lithotripsy, retreatment and efficacy quotient rates, and complications were assessed. The series consisted of 18 (62%) boys and 11 (38%) girls with an age range of 1-13 years (average age 7.0 +/- 3.5). Under fluoroscopic guidance, children were treated with a maximum 3,000 shocks at an average of 2.2 +/- 0.3 kV. Mean stone size was 8.2 +/- 3.2 mm (range 4-18). Success was defined as the lack of any visible stone fragments on posttreatment radiological evaluation. The mean number of sessions required was 1.5 +/- 0.8/patient (range 1-4). Complete clearance rate at 3 months was 86.2%. Re-treatment and efficacy quotient rates for distal ureteral stones were 41.4 and 55.6%, respectively. Complications such as urinary tract infection or steinstrasse occurred in 2 (6.9%) patients. Minor complications included petechial skin hemorrhage at the site of entry of shock waves in all patients. Our results show that shock wave lithotripsy for distal ureteral calculi with the Siemens Lithostar Modularis lithotriptor has a high success rate (86.2%) and efficacy quotient (55.6%) with negligible complications in children.
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