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[Extracorporeal shock-wave lithotripsy in infants. Study of its repercussions on the renal parenchyma]
O Traxer1, H Lottmann, F Archambaud
1Service de Chirurgie Urologique Pédiatrique, Fondation Hôpital Saint-Joseph, Paris.
Insights
Extracorporeal shock-wave lithotripsy (ESWL) is effective for treating kidney stones in infants. This study found no evidence of long-term kidney damage after ESWL treatment in young children.
Area of Science:
- Pediatric Urology
- Nephrology
- Medical Imaging
Background:
- Infant urolithiasis is rare but requires effective treatment.
- Assessing the safety and efficacy of extracorporeal shock-wave lithotripsy (ESWL) in this age group is crucial.
- Understanding potential long-term renal parenchymal damage is essential for pediatric patient care.
Purpose of the Study:
- To evaluate the efficacy of ESWL in infants under 2 years old.
- To assess potential long-term renal parenchymal damage using 99mTc DMSA renal scans.
- To establish ESWL as a safe and effective treatment for infant urolithiasis.
Main Methods:
- 12 infants (<2 years old) with kidney and ureter stones underwent ESWL.
- Treatment efficacy was assessed via clinical exams, conventional imaging, and 99mTc DMSA renal scans.
- Scans were performed pre-ESWL and at least 6 months post-treatment for follow-up.
Main Results:
- Stone-free status achieved in 84.6% after one ESWL session, 100% after two.
- Long-term follow-up (1 month to 4 years) showed no changes in blood pressure or renal function.
- No acquired renal parenchymal scarring was identified on DMSA scans.
Conclusions:
- ESWL is a highly effective treatment for infant urolithiasis.
- No renal parenchymal damage was observed in this study cohort.
- Long-term monitoring and pre/post DMSA scans are recommended for further validation.
Purpose:
To evaluate the efficacy of extracorporeal shock-wave lithotripsy (ESWL) in infants (less than 2-years-old) and study the potential long-term renal parenchymal damage by 99 m Tc DMSA renal scan.
Materials And Methods:
Between November 1993 and February 1998, 12 children underwent ESWL treatment for kidney and ureter urolithiasis with a Sonolith 3,000 lithotriptor (Technomed-Corp). All children were less than 2-years-old. Evaluation of treatment and its consequences was based on clinical examination, conventional imaging (plain abdominal radiography excretory urogram) and a DMSA renal scan performed 24 hours before ESWL and at least 6 months after treatment.
Results:
Treatment was successful in 84.6% of cases, by achieving stone-free status after one session and 100% after 2 sessions. Long-term follow-up (one month to four years) did not reveal any blood pressure or renal function changes. No acquired parenchymal scar was identified. On DMSA renal scan.
Conclusions:
The efficacy of ESWL in treating infant urolithiasis is clearly established. Renal parenchymal damage associated with ESWL did not appear in this study, but long-term follow-up mandatory (blood pressure) and each infant should have a DMSA renal scan before and after ESWL to confirm these preliminary results on a larger series.