Extracorporeal shock wave lithotripsy in prepubertal children: 22-year experience at a single institution with a single lithotriptor.

Abstract

PURPOSE:

The sophistication of percutaneous nephrolithotomy and ureteroscopy challenges the efficacy of ESWL for urolithiasis in prepubertal patients. We evaluated our long-term experience with ESWL in these patients and determined its efficiency.

MATERIALS AND METHODS:

We retrospectively reviewed the charts of all prepubertal patients who underwent ESWL. We evaluated the need for tubing, the 3-month stone-free rate, the need for additional ESWL, and the effect of stone size and location, and cystinuria on the 3-month stone-free rate.

RESULTS:

Between 1986 and 2008, 119 males and 97 females with a mean age of 6.6 years who had urolithiasis underwent ESWL using the Dornier HM3 lithotriptor. We treated 157 children with renal calculi with an average +/- SD diameter of 14.9 +/- 8.9 mm, of whom 66 (42%) required a tube in the urinary system. The 3-month stone-free rate was 80% and 31 patients (19.7%) needed an additional procedure. Stone location did not affect the stone-free rate but stone size did. We treated 59 patients for ureteral stones with an average stone length of 9.5 +/- 4.8 mm, of whom 41 (69%) required tube insertion. The 3-month stone-free rate was 78% and 13 patients (22%) needed an additional procedure. The 3-month stone-free rate did not depend on stone location or size. The rate was 37.5% in patients with cystinuria and 82.5% in all others (p <0.0001). Six patients (2.8%) had complications.

CONCLUSIONS:

The 3-month stone-free rate after ESWL in prepubertal patients is 80% and 20% of patients require additional procedures. ESWL is most effective for kidney stones less than 11 mm. ESWL has inferior results for cystine stones compared to other calculi. Complications are rare.

• Authors: Ezekiel H Landau, Ofer Z Shenfeld, Dov Pode, Amos Shapiro, Shimon Meretyk, Giora Katz, Ran Katz, Mordechai Duvdevani, Benjamin Hardak, Helio Cipele, Guy Hidas, Vladimir Yutkin, Ofer N Gofrit
• Journal: The Journal of urology (J Urol) Vol. 182 Issue 4 Suppl Pg. 1835-9 (Oct 2009) ISSN: 1527-3792 [Electronic] United States
• PMID: 19692011 (Publication Type: Journal Article)

Topics

• Child
• Child, Preschool
• Female
• Health Facilities
• Humans
• Infant
• Kidney Calculi (therapy)
• Lithotripsy
• Male
• Retrospective Studies
• Time Factors
• Ureteral Calculi (therapy)