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Pediatric extracorporeal shock wave lithotripsy: multi-institutional results
Berat Cem Özgür1, Lokman Irkilata1, Musa Ekici1
1Ankara Research and Training Hospital, Ankara, Altindağ - Turkey.
Insights
Pediatric extracorporeal shock wave lithotripsy (ESWL) is effective for treating pediatric urolithiasis, with a high stone-free rate and low complication risk. Further ESWL sessions may be needed for some cases.
Area of Science:
- Pediatric Urology
- Nephrolithiasis Treatment
- Minimally Invasive Surgery
Background:
- Urolithiasis affects children, necessitating effective treatment options.
- Extracorporeal shock wave lithotripsy (ESWL) is a common modality for stone removal.
Purpose of the Study:
- To evaluate the efficacy of pediatric ESWL using electrohydraulic lithotripters.
- To assess auxiliary procedures and complication rates associated with pediatric ESWL.
Main Methods:
- Retrospective evaluation of children (0-15 years) with urolithiasis.
- ESWL performed using two electrohydraulic lithotripter models between 2008-2012 in Turkey.
Main Results:
- 85.5% stone-free rate at 3 months post-ESWL.
- 33.7% required further ESWL sessions; 10 patients developed Steinstrasse, with 8 resolving spontaneously.
- Low complication rates: 3.9% UTI, 3.9% fever, 1.3% subcapsular hematoma.
Conclusions:
- ESWL demonstrates favorable outcomes in selected pediatric urolithiasis cases.
- Low rates of auxiliary procedures and complications are associated with pediatric ESWL.
- Stone diameter may influence stone-free rates, though not statistically significant in this study.
Aim:
To evaluate the efficacy, auxiliary procedures and complications of pediatric extracorporeal shock wave lithotripsy (ESWL) performed with electrohydraulic lithotripters.
Methods:
Children with urolithiasis, aged between 0 and 15, were retrospectively evaluated. ESWL was performed by using two different electrohydraulic lithotripters, Elmed Multimed Classic (Elmed Medical Systems, Ankara, Turkey) and E-1000 (EMD Medical Systems, Ankara, Turkey), between January 2008 and December 2012 in four different referral centers in Turkey.
Results:
85.5% of patients were stone-free at 3 months. Further ESWL treatment was needed in 33.7% of the cases (one session, n = 55; two sessions, n = 15; three sessions, n = 13). Steinstrasse occurred in 10 patients but 8 of them cleared completely during the follow-up period. Urinary tract infection was detected in 3 (3.9%), fever in 3 (3.9%) and a small subcapsular hematoma in one (1.3%) patient, respectively. When the stones were divided into two groups as those with diameters <10 mm and ≥10 mm, it was found that the stone-free rate was associated with stone diameter, and that the smaller diameters had higher but statistically insignificant stone-free rates (P = 0.196).
Conclusion:
ESWL yields favorable results with low rates of complication and auxiliary procedures in selected pediatric patients.
