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Shockwave lithotripsy for kidney stones as a first-line therapy in children younger than 2 years
Tariq Asi1, Hasan Serkan Dogan1, Mesut Altan1
1Department of Urology, Hacettepe University, Faculty of Medicine, Ankara, Turkey.
Insights
Extracorporeal shockwave lithotripsy (SWL) is a safe and effective treatment for pediatric kidney stones in children under 24 months. The Dogan nomogram accurately predicts stone-free rates in this young patient group.
Area of Science:
- Pediatric Urology
- Nephrology
- Minimally Invasive Surgery
Background:
- Urolithiasis incidence is rising globally in children, posing recurrence risks due to early stone formation.
- Extracorporeal shockwave lithotripsy (SWL) is a preferred non-invasive treatment for pediatric stones.
- Limited data exists on SWL safety and efficacy in infants under 24 months.
Purpose of the Study:
- To evaluate the effectiveness and safety of SWL in patients younger than 24 months.
- To assess the Dogan nomogram's accuracy in predicting stone-free rates in this cohort.
Main Methods:
- Retrospective analysis of 247 patients under 24 months undergoing SWL (2009-2019).
- Data analyzed for 260 renal units, defining success as stone-free status after the first SWL session.
- Factors predicting stone clearance were assessed via univariate and multivariate analyses.
Main Results:
- 56.9% of patients were stone-free after the first SWL session; overall efficacy was 57%.
- Complications occurred in 5.8% of patients, including steinstrasse, UTI, vomiting, and hematuria.
- Younger age (≤16 months), single stones, smaller stone size (<10 mm), and non-lower pole location predicted clearance; younger age and single stone remained significant on multivariate analysis.
Conclusions:
- SWL is a safe and effective first-line treatment option for pediatric urolithiasis in children under 24 months.
- The Dogan nomogram is a reliable tool for predicting SWL outcomes in this age group.
- SWL offers a viable alternative when other endourological procedures are not feasible.
Background:
The incidence of urolithiasis in children has risen worldwide over the last decades with geographical varieties. As pediatric patients begin forming stones earlier in life, they have high risk of recurrence. Extracorporeal shockwave lithotripsy (SWL) is a non-invasive treatment modality that is preferred in the management of pediatric stones. Reports about the safety and efficacy of SWL in patients younger than 24 months are scarce in the literature.
Objective:
The aim of the study was to evaluate the effectiveness and safety of SWL in patients younger than 24 months. The authors also aimed to assess the validity of the Dogan nomogram in predicting stone-free rates.
Study Design:
Between January 2009 and March 2019, data of 247 patients younger than 24 months at the time of SWL were retrospectively collected. Analysis was performed on 260 renal units. Success was considered in patients who were completely free of stones after the first session.
Results And Discussion:
The female/male ratio was 103/157, with a median age of 15 (5-24) months, a median stone size of 8 (3-30) mm and a median follow-up period of 7 (3-20) months. Multiple stones and lower calyx stones were observed in 19.6% (51/260) and 23.4% (61/260) of patients, respectively. Complications were detected in 5.8% (15/260) of patients (9 with steinstrasse, 3 with UTI, 2 with vomiting, 1 with hematuria). After the first session, 56.9% (148/260) of patients were stone-free. Forty-six of the failed 112 first sessions underwent second session. A total of 5 patients had a third session. The efficacy quotient was 57%. On univariate analysis, younger age (≤16 months), single stone, small stone size (<10 mm), and non-lower pole location were significant predictors of stone clearance. On multivariate analysis, younger age (=<16 months) and single stone remained significant. The Dogan nomogram score lower than 150 was found to be a good cutoff point to predict better stone clearance (Table).
Conclusion:
Shockwave lithotripsy is a safe and effective treatment modality in patients younger than 24 months and could be the first option in this particular age-group in whom the other endourological modalities are not always applicable. The Dogan nomogram is reliable in predicting the stone-free rate in this age-group.
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