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Extracorporeal shock wave lithotripsy for renal stones in children
D Picramenos1, C Deliveliotis, K Alexopoulou
1Department of Urology, Sismanoglion Hospital, Athens, Greece.
Insights
Extracorporeal shock wave lithotripsy (ESWL) effectively treats pediatric nephrolithiasis, achieving an 82% stone-free rate with minimal complications. This low-risk procedure is recommended as the primary treatment for children
Area of Science:
- Pediatric Urology
- Nephrology
- Surgical Technology
Background:
- Nephrolithiasis, or kidney stones, affects children, necessitating safe and effective treatment options.
- Extracorporeal shock wave lithotripsy (ESWL) is a non-invasive modality for stone removal.
Purpose of the Study:
- To evaluate the efficacy and safety of ESWL for treating kidney stones in pediatric patients.
- To determine the long-term stone clearance and complication rates following ESWL in children.
Main Methods:
- A cohort of 50 children (8 months to 14 years) with renal calculi underwent ESWL between 1986 and 1994.
- Treatments utilized Dornier HM3 and HM4 lithotripters under anesthesia, with 400-2000 shock waves at 18 kV.
- Follow-up included clinical assessment and DMSA scans to evaluate renal function and stone clearance.
Main Results:
- An overall stone clearance rate of 66% was observed at 1 month, reaching 82% stone-free after a mean follow-up of 33 months.
- Complications included 10 urinary tract infections and 5 cases of Steinstrasse; no permanent renal function impairment was detected.
- Children demonstrated high stone fragmentation and clearance rates, comparable to or exceeding adult outcomes.
Conclusions:
- ESWL is a safe and effective primary treatment for pediatric nephrolithiasis, including complex and staghorn calculi.
- The procedure offers a low-risk profile with high success rates, making it the treatment of choice for childhood kidney stones.
- ESWL's efficacy in children supports its use as an initial monotherapy approach for urinary tract lithiasis.
Abstract:
The aim of our study is to determine the efficacy and safety of extracorporeal shock wave lithotripsy (ESWL) as a method of treatment of nephrolithiasis in childhood. Between 1986 and 1994, 50 children with renal calculi were treated by ESWL in our department. The age of the children ranged from 8 months to 14 years. Thirty-three of them were boys and 17 girls. The stone location was in the renal pelvis in 38 cases, in the upper renal calyx in 4 cases, in the lower calyx in 2, while 6 children had staghorn calculi. The stone size ranged between 3 and 39 mm. All treatments were performed with Dornier HM4 except 12 children, all older than 10 years, who underwent ESWL with Dornier HM3. All ESWL procedures took place under general anesthesia or sedation with ketamine. The number of shock waves varied between 400 and 2,000 per treatment and the standard maximum generator voltage was 18 kV. The overall stone clearance rate at 1 month was 66%. Fourteen children with large residual fragments underwent a second ESWL procedure 3 months later. With a mean follow-up of 33 months, 41 children (82%) are stone-free. Ten children developed urinary tract infection and 5 Steinstrasse. Twelve children had a pre- and post-ESWL DMSA scan and no permanent impairment of renal function was observed. We conclude that ESWL is the treatment of choice for urinary tract lithiasis in childhood. It is a low-risk method, without serious complications, which yields as high a success rate in children as in adults. We believe that as the stone fragmentation and clearance is much higher in children that in adults, the method must be the initial approach and may be the monotherapy even in staghorn or complex stones.