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Extracorporeal shock-wave lithotripsy in children
1Division of Urology, Hospital Israelita Albert Einstein, São Paulo, Brazil.
Insights
Extracorporeal shock-wave lithotripsy is effective for treating pediatric urinary stones. This noninvasive procedure achieved high stone-free rates with minimal complications in children.
Area of Science:
- Pediatric Urology
- Nephrolithiasis Treatment
- Minimally Invasive Surgery
Background:
- Urinary calculi in children present unique management challenges.
- Extracorporeal shock-wave lithotripsy (ESWL) offers a noninvasive treatment option.
Purpose of the Study:
- To evaluate the efficacy and complication rates of ESWL in pediatric patients.
- To assess the effectiveness of Siemens Lithostar and Lithostar Plus devices for urinary stone treatment in children.
Main Methods:
- Retrospective analysis of 70 children (3-14 years) treated with ESWL between 1987-1994.
- 100 urinary calculi (caliceal, pelvic, ureteral, staghorn) were treated in 129 sessions.
- Follow-up included nephrotomogram or ultrasound at 1 day and 1-3 months post-procedure.
Main Results:
- Complete stone fragment removal was achieved in 98.5% of patients within 3 months.
- Re-treatment was required in 29.4% of cases.
- Complications (colic) occurred in 10% of patients, managed medically with uneventful convalescence.
Conclusions:
- ESWL using Lithostar and Lithostar Plus is an effective noninvasive treatment for pediatric urinary calculi.
- The procedure is suitable for both radiopaque and radiolucent stones in children.
- ESWL demonstrated a high success rate and acceptable complication profile in this pediatric cohort.
Objectives:
To analyze the efficacy and complication rates of extracorporeal shock-wave lithotripsy in children.
Methods:
Between 1987 and 1994, 8760 patients with urinary calculi were treated at our institution. A total of 70 (0.8%) children 3 to 14 years old underwent lithotripsy using the Siemens Lithostar or the Lithostar Plus. A total of 100 calculi in 74 urinary tracts were treated, requiring 129 extracorporeal shock-wave lithotripsy sessions. There were 47 caliceal stones, 31 in the renal pelvis, 16 in the ureter, and 6 staghorn stones. The Lithostar Plus was used in 8 patients, for 3 caliceal, 3 pelvic, and 2 staghorn stones. Follow-up consisted of nephrotomogram or ultrasound 1 day and 1 to 3 months postoperatively.
Results:
Complete removal of all stone fragments was achieved in 98.5% of the patients after 3 months. Re-treatment was necessary in 20 patients (29.4%). All patients were treated as outpatients, 51 (72.9%) with intravenous sedation and 19 (27.1%) without anesthesia. Complications were present in 7 patients (10%) who had colic and received medical treatment, and convalescence was uneventful.
Conclusions:
Extracorporeal shock-wave lithotripsy using the Lithostar and the Lithostar Plus has been demonstrated to be an effective noninvasive procedure to treat radiopaque and even radiolucent or slightly opaque urinary calculi in children.