Ungated extracorporeal shock wave lithotripsy: safe and effective in the pediatric population

Ungated extracorporeal shock wave lithotripsy (SWL) is unsynchronized to the patient's electrocardiogram. Although ungated extracorporeal shock wave lithotripsy (SWL) is associated with cardiac arrhythmias in adults, the incidence of arrhythmias in children has not been established. We report on the safety and efficacy of ungated SWL of renal calculi in children.

We evaluated all children less than 18 years of age undergoing ungated SWL for renal calculi. Lithotripsy with gradual incremental energy increase was used to treat the stones. Patients were monitored for arrhythmias and other standard monitoring intraoperatively and postoperatively.

Twenty-four consecutive children (10 boys and 14 girls) between 3.5 and 17 years of age underwent 32 ungated SWL procedures for renal calculi. The stone size ranged from 5 mm to 19 mm. No patient had cardiac arrhythmias or other intraoperative complications, required to have the procedure terminated prematurely, or conversion to gated SWL. The overall stone free rate was 87% based on radiographic imaging.

This series supports our initial series that ungated SWL is safe and efficacious in children less than 18 years of age. The arrhythmias associated with adults do no appear to occur in children undergoing ungated SWL.