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Extracorporeal shock wave lithotripsy in children: evaluation of the results considering the need for auxiliary
Tarkan Soygur1, Nihat Arikan, Ozcan Kilic
1Division of Pediatric Urology, Department of Urology, Faculty of Medicine, University of Ankara, Ibni Sina Hospital, Samanpazari, 06100 Ankara, Turkey. soygur@medicine.ankara.edu.tr
Insights
Extracorporeal shock wave lithotripsy (ESWL) effectively treats pediatric renal stones. Children
Area of Science:
- Pediatric Urology
- Nephrolithiasis Treatment
- Minimally Invasive Surgery
Background:
- Renal stones in children present unique management challenges.
- Extracorporeal shock wave lithotripsy (ESWL) is a common treatment modality.
- Evaluating ESWL efficacy and fragment passage in pediatric patients is crucial.
Purpose of the Study:
- To assess the effectiveness of ESWL for pediatric renal stones.
- To determine the ureteral transport capacity of stone fragments post-ESWL.
- To evaluate the necessity of additional procedures after ESWL.
Main Methods:
- Retrospective analysis of 60 children (72 stones) treated with ESWL (PCK V5 lithotriptor).
- Exclusion of patients with anatomical abnormalities and staghorn calculi.
- Stone fragmentation assessed via plain film or renal ultrasound 24-48 hours post-ESWL.
Main Results:
- Stone-free rates of 92.8% (stones <10mm) and 81.2% (stones 10-28mm) after one ESWL session.
- 11.6% of patients developed ureteral steinstrasse, which resolved with follow-up.
- No patients required adjunctive procedures like double-J stents or nephrostomy tubes.
Conclusions:
- Pediatric ureters can effectively transport stone fragments after ESWL.
- Expectant management is typically sufficient, even with steinstrasse.
- Interventional procedures should be reserved as a last resort.
Objective:
To retrospectively evaluate the efficacy of extracorporeal shock wave lithotripsy (ESWL) in children with renal stones, with regard to ability of ureters to transport the fragments, and need for adjunctive procedures.
Patients And Methods:
Between January 2000 and November 2004, 60 children (24 girls and 36 boys) with a total of 72 stones of the upper urinary tract were treated by ESWL using a PCK V5 lithotriptor. Patients with anatomical abnormalities and staghorn stones were excluded from the study. Stone size ranged from 4 to 28 mm. Mean number of shock waves was 1430 (range 600-2000) per ESWL session and mean energy used for stone disintegration was 12 kV (range 6-18). At 24-48 h after ESWL, a plain film or renal ultrasound was obtained to evaluate stone fragmentation.
Results:
Our stone-free rate after one session of ESWL was 92.8% and 81.2% for patients with stones smaller than 10mm and stones between 10 and 28 mm, respectively. Seven (11.6%) patients developed distal ureteral steinstrasse, and the stone size was 15-20 mm and 20-28 mm in two and five patients, respectively. The steinstrasse completely cleared under meticulous follow-up. No patient needed an adjunctive procedure, such as a double-J stent or nephrostomy tube placement, or ureteroscopic stone manipulation.
Conclusion:
A child's ureter is capable of transporting the fragments after lithotripsy. Interventional procedures should be a last resort. Expectant management is usually adequate even in patients who develop steinstrasse after ESWL.
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