The aim of this study was to determine the long-term functional outcome of kidneys in children with urolithiasis treated by means of extracorporeal shock wave lithotripsy (ESWL). The effectiveness and safety of this method in the management of pediatric urinary stone disease was also studied. This prospective study enrolled 84 children, 33 boys (age: 9.1 +/- 3.8 yrs) and 51 girls (age: 9.6 +/- 3.9 yrs), with urolithiasis who were treated using a second-generation "Siemens" Lithostar lithotriptor, in the period between 1988 and 1998. Dynamic kidney scintigraphy using (99 m)Tc-DTPA was done prior to, immediately following ESWL treatment, three months later, and again after an observation period of 12 - 67 months (38 +/- 13 months). Immediate fragmentation rate was 90 %, while the calculus clearance rate was 61 %. Glomerular filtration rate (GFR), measured by clearance of (99 m)Tc-DTPA, immediately after an ESWL treatment of 107 +/- 6 ml/min was significantly lower compared to the pretreatment value of 118 +/- 7 ml/min, but returned three months later to 121 +/- 6 ml/min, and to 131 +/- 10 ml/min at the end of the observation period. A separate analysis was performed on three groups of patients treated by ESWL: with acute calculous disease, chronic calculous disease, and chronic calculous with partial stasis. ESWL treatment in children with acute obstruction was associated with an immediate increase in GFR; however, in chronic calculous disease a decrease in GFR was found. A return of GFR to the pretreatment level was observed at the three-month control in these patients. In patients with acute stone obstruction, at 3 and 12 - 67 months after ESWL treatment, GFR of the treated kidney was found to be significantly increased compared to the pretreatment level. In contrast, in children with chronic calculous disease this increase was modest. This study has demonstrated ESWL to be an effective treatment option for urinary calculi management, which can be safely performed in a pediatric population without long-term effects on the growing kidneys.
The main objective of this paper was to evaluate the efficacy and safety of the management of pediatric urolithiasis by extracorporeal shock wave lithotripsy (ESWL). Between November 1988 and July 2000, 165 renal stones, 53 ureteral stones, and 5 bladder stones were treated in 126 pediatric patients using Siemens Lithostar lithotriptor. The ESWL treatments ranging from 1 to 7 were needed per patient (mean: 2.1). One ESWL session was performed for 49.6% of stones, two for 24.6%, three for 13.0 %, four for 5.6% and > 4 for 8.2%. The success rate for renal stone units (asymptomatic fragments less than 4 mm) was 88.2%, stone-free rate was 49.0%. The stone-free rate for ureteral stone units was 87.5%, but was 75% for bladder stones. The overall results of ESWL treatment in 126 children was satisfactory: the success rate was 90.5%, stone-free rate was 51.6%, residual fragments > 4 mm were 9.5%. General anesthesia was required in 65 children (136 treatments) under the age of 10, and only in 18 children (40 treatments) in the age 11-14. Auxiliary procedures, such as double J stent and percutaneous nephrostomy (PCN) were used in 19 and 7 patients, respectively. Perirenal hematoma in one patient and hematomas in enteric wall in another one patient were the only major complications managed conservatively without consequences. Low energy lithotripsy with the Siemens Lithostar in our series of pediatric patients was safe and relatively effective.
The Siemens Lithostar Litotriptor was used to treat 6 children with cystine nephrolithiasis, previously treated by open surgery. Five children had renal calculi (3 multiple caliceal, 2 pelvis) and one had ureteral calculus. Stone size ranged from 0.2-2.5 cm in diameter, and stone burden was from 0.24 to 10.81 cm3 per kidney. From one to 4 ESWL sessions per unit were applied, with a total of 1,800 to 12,000 shock waves. The stone free rate at 3 months was 50%. A complete elimination was obtained with cystine stones in renal pelvis and ureter, however, up to 4 ESWL treatments failed in caliceal stones. Rather location of cystine calculi than previous surgery was associated with ESWL success rate. Two patients with positive urine cultures were successfully treated with appropriate antibiotics before ESWL was attempted. Perirenal hematoma was major complication demonstrated by radionuclide scintigraphy in one patient, and resolved spontaneously by 3 months. In the combined treatment of cystine urolithiasis in children ESWL, as auxillary procedure, was safe and effective in pelvis stone but failed in caliceal stones. Medical dissolution for retained fragments was found effective.
We report a combined urologic treatment of bilateral staghorn stones, developed in a boy after prolonged immobilization for limb fractures. He underwent percutaneous nephrostolithotomy (PCNL) on the left side, and after three months pyelolithotomy and nephrolithotomy for stasis in the right kidney, followed by ESWL for residual calculus in the left ureter. He becomes stone free, with apparently normal kidney function.
Ob jec tive: Sig nif i cant ad vances in the sur gi cal treat ment of intracapsular frac tures of the fem oral neck be gan in the mid-twen ti eth cen tury, because of the better un der stand ing of the char acter is tics and biomechanics of the frac tures. The aim of this study is to pre cisely iden tify the charac ter is tics of the frac tures, that will be taken into ac count in the in di vid u al iza tion of treat ment of intracapsular frac tures of the fe mur. Ma te ri als and Meth ods: We an a lyzed, in a ret ro spective study, 148 pa tients with intraarticular frac tures of the fem o ral neck from the reg is try of the Or tho paedic De part ment in Pozarevac, in the pe riod from 2009 to 2014. Frac tures were clas si fied by the mod i fied Gar den's clas si fi ca tion. Gar den type III frac tures were di vided into two sub-types. Gar den type IIIa included frac tures in which the dis tance be tween the frag ments of the me dial cor tex was less than ½ the diam e ter of the fem o ral neck. Gar den type III b included frac tures in which the dis tance of the me dial cor tex of the frac ture frag ments was larger than ½ the di am e ter of the fem o ral neck. Pa tients with the Gar den type I frac ture (6 cases), Gar den type II (22 cases), Gar den type IIIa (35 cases) and Gar den type IV (5 cases) were treated by closed re duc tion and in ter nal fix a tion. Pa tients with Gar den type IIIb (28 cases) and Gar den type IV (52 cases) were treated by pri mary to tal hip re place ment. Re sults : All frac tures in pa tients with the frac ture Gar den type I (6 cases) and Gar den type II (22 cases) have healed and avascular ne cro sis did not oc cur. In the group of pa tients with the Gar den type III b fracture, 3 pa tients with non-un ion were treated with to tal hip arthroplasty. In the same group in two pa tients avascular ne cro sis oc curred. In the group of pa tients with the Gar den type IV fracture who were treated by closed re duc tion and in ternal fix a tion (5 cases), two pa tients with non-un ion were treated with to tal hip arthroplasty. In pa tients with Gar den sub-type III b, in the time of mon i tor ing we found 4 dis lo ca tions af ter pri mary to tal hip arthroplasty. One pa tient un der went acetabular re vision in the same group. In the group of pa tients with Gar den type IV frac ture, we found 7 dis lo ca tions after to tal hip arthroplasty and two pa tients un der went acetabular re vi sion sur gery. Con clu sion: Our re sults in di cate that frac tures Garden type I, II and Gar den type III a can be suc cessfully treated with in ter nal fix a tion. Frac tures Gar den type III b and IV should be treated by pri mary hip arthroplasty, be cause of in ter nal fix a tion of these frac tures lead to un sat is fac tory re sults.
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