Extracorporeal shock wave lithotripsy for the treatment of urinary stones in children

To provide the reader with an overview about the role of shock wave lithotripsy (SWL) in the management of urinary stones in children, and the complications associated with the procedure.

We performed a non-systematic review of the English literature to ascertain the success rate of SWL, the need for ancillary procedures such as stenting of the urinary tract or endoscopic manipulation, and the possible side effects and complications of the procedure.

Both renal and ureteric stones can be amenable to SWL. The latter can be performed in patients of any age including low birth weight infants. Paediatric series of SWL report 3-month stone-free rates of 70 to 100%. High rates can be achieved also dealing with large stones of 20-30 mm in diameter, staghorn calculi and stones located in the lower-pole. Current data seem to suggest that systematic preoperative insertion of ureteric stents is unnecessary. After the procedure, complications occur in about 20% of cases and include haematuria, steinstrasse, ureteric obstruction, and urinary tract infection with or without fever. Most of these complications are self-limiting and require only medical treatment. Haematoma formation is exceptional after SWL and the procedure does not seem to damage long-term renal growth and function, or cause any damage to the surrounding anatomical structures.

Data from current literature warrant an attempt of treatment of urinary stones by SWL in many paediatric cases including very young patients, patients with big stones or stones in lower-poles, and patients with staghorn calculi. The procedure seems to be safe.