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Extracorporeal shockwave lithotripsy in infants
Prem A Ramakrishnan1, Mohammed Medhat, Younis H Al-Bulushi
1Departments of Urology, Accident, Emergency and General Surgery, Armed Forces Hospital, Muscat, Sultanate of Oman.
Insights
Extracorporeal shockwave lithotripsy (ESWL) effectively treats pediatric upper urinary tract stones in infants. While short-term complications are minimal, long-term monitoring is crucial for managing potential stone recurrence and renal function.
Area of Science:
- Pediatric Urology
- Nephrology
- Minimally Invasive Surgery
Background:
- Pediatric urolithiasis is uncommon, with limited data on minimally invasive treatments for infants.
- This study details a single-center experience using extracorporeal shockwave lithotripsy (ESWL) for infants with upper urinary tract calculi.
Purpose of the Study:
- To evaluate the efficacy and safety of ESWL for treating upper urinary tract stones in infants.
- To assess short-term and long-term outcomes, including stone-free rates, complications, and recurrence.
Main Methods:
- Seventy-four infants (3-24 months) with upper urinary tract calculi were treated with ESWL.
- Data collected included patient and stone characteristics, risk factors, treatment parameters, and clinical outcomes.
- Follow-up assessments were conducted over a 14.5-year period.
Main Results:
- Successful outcomes were achieved in 97% of infants at 3-month follow-up (88% stone-free, 9% clinically insignificant fragments).
- Retreatment was needed in 35% of patients; 7% required auxiliary procedures, and 3% needed secondary operative procedures.
- Major complications occurred in 7% of patients, including ureteral obstruction and sepsis; long-term follow-up revealed stone recurrence in some, but no significant renal function decline.
Conclusions:
- ESWL is an effective and safe treatment modality for upper urinary tract calculi in infants.
- While short-term complications are infrequent, long-term follow-up is essential for monitoring outcomes and managing potential issues.
Introduction:
Pediatric urolithiasis is relatively uncommon and limited information is available on the application of minimally invasive management modalities in young children. We present a single centre experience with extracorporeal shockwave lithotripsy (ESWL) for infants with upper urinary tract calculi.
Material And Methods:
A total of 74 infants aged 3 months to 24 months with upper urinary tract calculi were treated with ESWL under general anesthesia using the Wolf 2500 and the 2501 Piezolith lithotriptors over a 14 and a half-year period. Patient and stone characteristics, risk factors for urolithiasis, treatment parameters, clinical outcomes and long-term follow-up were assessed and recorded.
Results:
The mean patient age was 14.5 (range 3 to 24) months. The mean renal stone size was 18.2 (range 7 to 32) mm while the mean ureteral stone size was 9.4 (range 5 to 14) mm. Metabolic abnormalities, structural anomalies and urinary tract infections were identified as contributory factors for stone formation in 34% of the infants. At the 3-month follow-up there was an overall successful outcome in 72 infants (97%) that included 65 (88%) who were rendered stone-free and 7 (9%) who had clinically insignificant stone fragments. Retreatment was required in 27 (35%) patients, auxiliary procedures after ESWL were needed in 5 (7%) and secondary operative procedures were required in 2 (3%). Major complications were encountered in 5 (7%) patients that included complete ureteral obstruction with sepsis in 2, partial ureteral obstruction in 1 and febrile urinary tract infection in 2 other children. Long-term follow-up was recorded in 39 infants: 8 developed recurrent stones, 2 had stone regrowth and 1 developed mild hypertension but none had significant deterioration of renal function.
Conclusions:
ESWL is an effective treatment for upper urinary tract calculi in infants. In the short-term, complications are minimal but long-term follow-up is important.
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