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Lithostar extracorporeal shock wave lithotripsy in children
E Abara1, P A Merguerian, G A McLorie
1University of Toronto Urolithiasis Program, Division of Urology, Wellesley Hospital, Ontario, Canada.
Insights
Extracorporeal shock wave lithotripsy (ESWL) using the Siemens Lithostar device effectively treated pediatric kidney and ureteral stones. High success rates and minimal complications were observed, indicating a safe and effective short-term solution for pediatric calculi.
Area of Science:
- Pediatric Urology
- Nephrolithiasis Treatment
- Medical Device Technology
Background:
- Pediatric kidney and ureteral stones (calculi) pose unique treatment challenges.
- Minimally invasive techniques are preferred for treating stones in children.
- The Siemens Lithostar lithotriptor is a device designed for stone fragmentation.
Purpose of the Study:
- To evaluate the safety and efficacy of the Siemens Lithostar lithotriptor for treating renal and ureteral calculi in children.
- To determine stone-free rates and overall success rates following lithotripsy.
- To assess the complication profile associated with the procedure in a pediatric population.
Main Methods:
- A cohort of 20 pediatric patients (ages 4-17) with renal or ureteral calculi were treated with the Siemens Lithostar lithotriptor.
- Calculi characteristics including location and size were documented.
- Treatment outcomes were assessed based on stone-free status and residual fragment size at 3 months, with consideration for single versus multiple treatments.
Main Results:
- A total of 34 calculi were treated, located in the renal pelvis (47%), lower calix (29%), upper calix (12%), middle calix (3%), and upper ureter (9%).
- Stone sizes ranged from 2x2 mm to 40x20 mm, averaging 10x7 mm.
- The 3-month stone-free rate was 60% after one treatment, increasing to 80% with multiple treatments. The overall success rate (stone-free or residual fragments ≤4 mm) was 95%.
Conclusions:
- Extracorporeal shock wave lithotripsy (ESWL) with the Siemens Lithostar device is a safe and effective short-term treatment for pediatric renal and ureteral calculi.
- The procedure demonstrated a high success rate and a low incidence of major complications in the studied pediatric cohort.
- ESWL offers a viable therapeutic option for managing nephrolithiasis in children.
Abstract:
The Siemens Lithostar lithotriptor was used to treat 20 children (4 to 17 years old) with renal or ureteral calculi. Two patients had bilateral renal and 2 had ureteral calculi. Of 34 calculi treated 47% were in the renal pelvis, 29% in the lower calix, 12% in the upper calix, 3% in the middle calix and 9% in the upper ureter. Stone size ranged from 2 X 2 to 40 X 20 mm. and averaged 10 X 7 mm. Of the children 60% were treated while they were under neuroleptic anesthesia. No major complications were encountered. The 3-month rate free of stones after 1 treatment was 60% and increased to 80% with multiple treatments. The success rate, defined as being either free of stones or with residual fragments equal to or less than 4 mm. in diameter, was 95%. We conclude that lithotripsy with the Lithostar device in children, at least for the short term, is safe and effective.