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[Pediatric Extracorporeal Shock Wave Lithotripsy]
M Fernández Ibieta1, A Bujons Tur2, J Caffaratti Sfulcini2
1Servicio de Cirugía Pediátrica. Hospital CU Virgen de la Arrixaca. Murcia.
Insights
Extracorporeal Shock Wave lithotripsy (ESWL) is effective for pediatric urolithiasis. Younger children and smaller stones yield the best outcomes, with ESWL demonstrating safety and efficiency in this population.
Area of Science:
- Pediatric Urology
- Nephrolithiasis Management
- Minimally Invasive Surgery
Background:
- Pediatric urolithiasis management relies heavily on Extracorporeal Shock Wave lithotripsy (ESWL).
- Evaluating the efficacy and complication rates of ESWL in children is crucial for optimizing treatment protocols.
Purpose of the Study:
- To assess the effectiveness of ESWL in managing pediatric urolithiasis.
- To identify factors influencing stone-free rates and complication incidence in children treated with ESWL.
Main Methods:
- Retrospective review of pediatric patients treated with ESWL between 2003 and 2012.
- Analysis of etiology, clinical presentation, stone-free status, and complications using SPSS software.
Main Results:
- 80.3% stone-free rate achieved in 90 children (122 stones, 162 sessions).
- Higher success rates observed in younger children (<5 years) and smaller stones.
- Complications (10.4%) were associated with larger, staghorn, and struvite calculi.
Conclusions:
- ESWL is a safe and efficient treatment for pediatric urolithiasis.
- Optimal outcomes are associated with younger patient age and smaller stone size.
- Careful patient selection is important, especially for complex stone burdens.
Introduction:
Extracorporeal Shock Wave lithotripsy (ESWL) is the cornerstone of pediatric urolitiasis management. We evaluated its efficacy and complications in a series of children.
Material And Methods:
Children who were managed with ESWL between 2003 and 2012 were retrospectively reviewed. We studied etiology, clinical presentation, stonefree ratio and relevant complications. SPSS 17.0 software was used.
Results:
90 children aged 0 to 10 years (median 2.9 years) were included in the study; that accounted for 122 stones and 162 ESWL sessions. Mean follow up was 20 months. Mean stone diameter was 12.2 mm. (range 4-25). Most prevalent clinical sign was urinary infection (55.6%, 50 patients). 75.4% of the lithiasis were found in renal pelvis or calices. A mean of 1.42 ESWL sessions per stone was performed. Stonefree status was reached in 80.3% (98) of the lithiasis. This rate was higher in patients below 5 years of age (86.1% vs., 69.8%, p=0.03), and worse in staghorn calculi (66% vs. 87.2%) and cystine ones (30% vs. 84.8%, p<0.001). We observed 17 complications (10.4% among 162 sessions), 6 UTIs, 6 episodes of fever and 6 episodes of UTI associated with steinstrasse. Almost all complications were associated with bigger size, staghorn calculi and struvite.
Discussion:
Best results are found in younger patients and small calculi. ESWL is a safe and efficient procedure in pediatric patients.
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