Arch Hellen Med, 16(5), September-October 1999, 473-479
sequelae of extracorporeal shock wave lithotripsy
in children with nephrolithiasis
E. KARAYOTIS,2 A. STEFANIDIS,1
P.A. ANDROULAKAKIS,1 C. DIMOPOULOS2
1Department of Pediatric Urology, "Agia Sophia" Children's Hospital,
2Lithotripsy Unit, Department of Urology, University of Athens, Sismanoglio Hospital, Athens, Greece
Extracorporeal shock wave lithotripsy (ESWL) is the preferred method for the
treatment of urolithiasis in adults, with a success rate of 40-90%. For children
aged <14 years, although ESWL has been used spo radically, there are not
sufficient data regarding its results or safety. The aim of this study was to
investigate the efficacy and safety of ESWL in children with nephrolithiasis.
METHOD Nephrolithiasis in 16 boys and 6 girls aged 6-14 years was managed by ESWL. The patients had no clotting disorders, urinary infection, cystinuria or structural malformation of the kidneys and urinary tract. Stones were bilateral in 2 patients (=24 renal units available for treatment) and were located respectively in the renal pelvis (14 renal units), upper ureter (1) or calyces (9). Except for 4 calculi sized 2-3 cm, all the stones measured <2 cm. Electrohydraulically generated shock waves were administered with an intensity <18 kV (or <600 Bar) with 600-1500 (mean 1250) shocks per session.
RESULTS ESWL was considered successful if stone disintegration showed complete kidney clearance or the presence of a residual fragment of <4 mm on a plain KUB film 1 month after treatment. According to these criteria, ESWL was successful in 10/22 patients (45.4%) or 15/24 renal units (62.5%). For pelvic and upper ureter stones the success rate was 71.4% (10/14 renal units) and for calyceal stones 55.5% (5/9 renal units). When stone size and number were considered, ESWL was successful in 15/19 (80%) solitary stones <2 cm (pelvic or calyceal) but unsuccessful in multiple (0/4) or large, >2 cm (0/4) stones. The post-ESWL GFR was similar to pre-treatment levels, and no kidney hematoma was noted on U/S following ESWL.
CONCLUSIONS ESWL with intensity <18 kV (or 600 Bar) and 1500 shocks/session is safe for the treatment of nephrolithiasis in children. The success rate for solitary pelvic or calyceal stones measuring <2 cm is 80% but the technique is ineffective for multiple calyceal or large (>2 cm) pelvic stones.
Key words: Extracorporeal shock wave lithotripsy, Nephrolithiasis in children.