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Limitations of extracorporeal shock wave lithotripsy for urinary tract calculi in young children
P Losty1, R Surana, B O'Donnell
1Department of Paediatric Surgery, Our Lady's Hospital for Sick Children, Dublin, Ireland.
Insights
Extracorporeal shock wave lithotripsy (ESWL) showed limited success in pediatric urinary tract stones, clearing only 8 of 28 patients. Surgery remains crucial for complex cases and ESWL failures in children.
Area of Science:
- Pediatric Urology
- Nephrolithiasis Management
- Minimally Invasive Surgery
Background:
- Urinary tract calculi in children present unique management challenges.
- Extracorporeal shock wave lithotripsy (ESWL) has been widely used, but its efficacy in pediatric populations is under scrutiny.
- The evolving role of ESWL necessitates re-evaluation, especially for complex stone burdens.
Purpose of the Study:
- To assess the outcomes of extracorporeal shock wave lithotripsy (ESWL) as monotherapy versus surgical interventions in pediatric patients with urinary tract calculi.
- To determine the effectiveness of ESWL in different types of pediatric stones, including staghorn and multiple calculi.
- To evaluate the necessity and success rates of surgical management in cases where ESWL is unsuitable or fails.
Main Methods:
- Retrospective analysis of 28 pediatric patients treated for urinary calculus disease over a 5-year period.
- Categorization of treatments into ESWL monotherapy and primary surgical intervention.
- Detailed recording of stone clearance rates, stone burden (staghorn, multiple, solitary), and need for adjuvant therapies.
Main Results:
- ESWL monotherapy achieved stone clearance in only 8 out of 13 pediatric patients.
- Five patients treated with ESWL monotherapy required subsequent surgery due to multiple calculi.
- Primary surgery was performed on 14 patients deemed unsuitable for ESWL, with 12 achieving stone clearance.
- One patient with a small solitary renal calculus passed the stone spontaneously.
Conclusions:
- ESWL monotherapy demonstrates limited efficacy in clearing urinary tract stones in children, achieving clearance in only 8 of 28 cases.
- Surgical intervention remains a vital component in managing pediatric urolithiasis, particularly for large staghorn calculi, multiple stones, and ESWL failures.
- The study underscores the continued importance of surgical strategies alongside or as an alternative to ESWL in pediatric stone disease management.
Abstract:
Despite success rates with a variety of urinary tract calculi, there is growing concern that extracorporeal shock wave lithotripsy (ESWL) has limitations and that its role needs to be redefined. We report the outcome of 28 consecutive children (age range, 6.5 months to 7 years; mean, 3.6 years) with urinary calculus disease, treated over a 5-year period. Thirteen patients had ESWL monotherapy, and 8 achieved stone clearance. The other 5 children in the ESWL monotherapy group, all with multiple calculi, required surgery to render them stone free. A further 14 patients (6 staghorn calculi, 6 multiple calculi, 1 solitary renal, and 1 child with multiple bladder calculi) were considered unsuitable for ESWL and had primary surgery. Twelve of those 14 were cleared by open surgery, one had residual fragments successfully treated by ESWL, and one still awaits adjuvant ESWL. One child had a solitary renal calculus (5 mm) which passed spontaneously. This study demonstrates that ESWL monotherapy cleared stones in only 8 of 28 patients and clearance in a further 6 was achieved with surgery. Surgery will continue to play an important role in the management of paediatric urolithiasis for large staghorn, multiple urinary tract calculi and lithotripsy failures.