Effect of Extracorporeal Shock Wave Lithotripsy on Renal Function and Body Height in Pediatric Patients

Thomas, Raju; Frentz, Johnette; Harmon, Edwin; Frentz, Gerda

doi:10.1016/s0022-5347(17)36818-0

Cited by 75 publications

(32 citation statements)

References 14 publications

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“…We feel a PUJ balloon catheter can cause ischaemia in very young children, and is also costly in our healthcare system. Radioisotope scans and renal function tests detect no significant harmful effects of PCNL on the kidneys [18,19], and we confirm these findings.…”

Section: Discussionsupporting

confidence: 82%

Percutaneous nephrolithotomy in children before school age: experience of a Pakistani centre

Zaidi

2004

BJU International

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RESULTSThere were 30 renal units in 29 children (median age 3.8 years, range 1.4-5). Because of poor growth the mean ( SD ) body weight of the children was only 12.2 (2.8) kg, which is near the 50th percentile for children of mean age 3.5 years. The median (range) stone burden was 2.35 (1.3-6) cm; 60% of the patients had single stones while 28% had more than five. There were five staghorn stones. All PCNL was primary and with one puncture, using a 17 F angled nephroscope; stones were fragmented using a pneumatic lithoclast. After PCNL stones were completely cleared in 60% of the renal units, which increased to 100% after combining it with extracorporeal shockwave lithotripsy. The median (range) follow-up was 24.9 (4-51) months; the overall complication rate was 6%. In the long follow-up hypertension was not detected in any child and isotopic renograms in 17 kidneys detected no new scarring or loss of renal function. CONCLUSIONPCNL is a safe and effective for treating renal stones in very young children. KEYWORDS PCNL, renal stones, pre-school children OBJECTIVETo review our experience of percutaneous nephrolithotomy (PCNL) in children before school age, and determine its efficacy and safety in this age group. PATIENTS AND METHODSThe records of children aged £ 5 years undergoing PCNL were reviewed. Variables assessed included stone number, size, location and type. The PCNL puncture site and number were also recorded. We reviewed stone clearance with PCNL, ancillary procedures used, complication rates and follow-up status of the children.

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Section: Discussionsupporting

confidence: 82%

Percutaneous nephrolithotomy in children before school age: experience of a Pakistani centre

Zaidi

2004

BJU International

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“…Because the focal zone is small, there was no need for lung shielding from the shock waves, however, the long-term effects of ESWL on the developing renal parenchyma in children are not yet clear. Although many investigators [9][10][11] have reported shock wave lithotripsy to be safe, doubt still persists. 12 It might be prudent to use open surgery or percutaneous nephro-lithotomy for large staghorn calculi that would require many sessions of shock wave treatment.…”

Section: Discussionmentioning

confidence: 99%

Extracorporeal Shock Wave Lithotripsy in Children

Onuora

Koko

Turki

et al. 2001

Annals of Saudi Medicine

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The advent of extracorporeal shock wave lithotripsy (ESWL) as a noninvasive technique has revolutionalized the management of urinary tract calculi. The technique is considered a safe and effective treatment for urinary lithiasis in adults. However, the application of this modality of treatment in children has followed rather slowly. Although evidence has accumulated on the efficacy of ESWL in treating calculi in children, 1-3 the effects of shock waves on the pediatric urinary tract have still not been adequately researched. Indeed, ESWL is considered by some to be contraindicated in children. 4 As a contribution to the growing data in this field, we present a retrospective study on our use of a second-generation lithotripter (Siemens Lithostar) in the treatment of renal calculi in children in Saudi Arabia. Patients and MethodsBetween January 1993 and December 1998, 67 children with stones in the urinary tract were treated by ESWL, using the Siemens Lithostar lithotripter. There were 38 boys and 29 girls, and their ages ranged from 5-16 years (mean 12.9). Prior to shock wave treatment, all patients underwent renal and bladder sonography, intravenous urography (IVU), blood tests for renal function, coagulation profile, urine analysis and urine culture. Patients with allergy had a dimercapto succinic acid (DMSA) renal scan.Of the 63 patients, 53 (79%) presented with pain; 8 with microhematuria, and one with gross hematuria. Urine culture was positive in 8 children (12%), and they were given appropriate antibiotic therapy before stone treatment. Stone disease was associated with horseshoe kidney in one case, while three other children had previously undergone surgery for posterior urethral valve, pelvi-ureteric junction obstruction, and meatal stenosis, respectively.There were 56 renal stones (37 pelvic, 16 calyceal, and 3 staghorn). Eleven children had ureteric and three had bladder stones. Only three children had radiolucent calculi, with bilateral renal calculi in three others. The stone size ranged from 4 to 40 mm (mean 16). ESWL was done as an outpatient procedure in 20 children. Fifteen patients with bulky stones (>20 mm) had internal stents before treatment, and three had placement of ureteric catheters for visualization of radiolucent stones. General anesthesia was used in 19 patients, usually those below the age of 12 years. The rest received pethidine for sedation and analgesia. The mean number of shocks delivered was 3000, and the generator voltage ranged from 16 to 19 kV. Most of the patients required only one ESWL session (mean 1.7).Plain abdominal x-ray was done on the day after treatment and repeated monthly in the outpatient department. Patients with radiolucent stones and those with bulky stones were followed with ultrasound scans. A patient was regarded as stone free if no stone fragment was discernible, and the time of this status was noted. A "successful outcome" was defined to include stone-free patients and those patients with stone fragments less than 4 mm, which were deemed passable. Results...

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“…The first generation of electrohydraulic extracorporeal lithotriptors (Dornier HM3) requires specific equipment for positioning young children and protecting their lungs from the shock waves [ 1,[4][5][6][7], The majority of later extra corporeal lithotriptors enables children to be treated with out difficulty in positioning or particular protection in relation to their size [3,[8][9][10][11][12].…”

Section: Discussionmentioning

confidence: 99%

“…The ovaries are exposed during treat ment of calculi in the lower ureter, but animal experimen tation has not revealed any anomalies in the number of follicles or disturbance of the menstrual cycle or fertility [1,3-8, 12, 15-20], Despite numerous studies, the delayed consequences of ESWL, notably on renal function and growth or on arterial pressure, remain unrecognized. However, clini cally no significant disturbances have been detected [2,11,21]. Biologically, the urinary excretion of various microglobulins and enzymes is only temporarily dis turbed and no serum anomalies arc discernible [22][23][24][25][26][27][28][29][30], Certain scintigraphic renal explorations have, on the oth er hand, brought to light localized sequel lesions which escaped the other techniques of medical imaging [2,11,31,32], Animal experimentation confirms the existence of scarring sites, but does not detect any disturbance in over all growth of the subjects or any notable anomaly in their renal development [33][34][35][36][37][38].…”

Section: Discussionmentioning

confidence: 99%

Childhood Urolithiasis: Urological Management of Upper Tract Calculi in the Era of Extracorporeal Shock-Wave Lithotripsy

Robert

Drianno²,

Guiter³

et al. 1996

Urol Int

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Objective: To evaluate the management of urolithiasis in children since the development of extracorporeal shock-wave lithotripsy (ESWL). Methods: Between 1988 and 1994, 37 children, aged from 2 to 15 years (mean 10), with upper tract urolithiasis were evaluated and treated. Lithogenic metabolic disorders or anomalies of the urinary tract were present in 11 children (30%). Urolithiasis was multiple in 9 cases and bilateral in 2 cases. A total of 47 renal (30) or ureteral (17) stones were managed, of which 5 were partial or complete staghorn calculi. Initial treatment was surgery in 4 cases (1 nephrectomy, 1 partial nephrectomy and 2 pyelolithotomies) and piezoelectric ESWL in 43 cases. Results: The overall ESWL success rate was 82.2%, with auxiliary endoscopic procedures in 3 cases. ESWL failures required surgical stone removal in 5 cases, endoscopic ureterolithotripsy in 1 case and electrohydraulic ESWL in 1 case. Residual fragments after pyelolithotomies were also treated by ESWL. Conclusion: ESWL is the mainstay of treatment of childhood upper tract urolithiasis, but other therapeutic methods retain specific indications. Its application requires great vigilance and its long-term effects are uncertain. It is therefore important to rule out any underlying pathology and where possible to prevent further stone formation.

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Effect of Extracorporeal Shock Wave Lithotripsy on Renal Function and Body Height in Pediatric Patients

Cited by 75 publications

References 14 publications

Percutaneous nephrolithotomy in children before school age: experience of a Pakistani centre

Percutaneous nephrolithotomy in children before school age: experience of a Pakistani centre

Extracorporeal Shock Wave Lithotripsy in Children

Childhood Urolithiasis: Urological Management of Upper Tract Calculi in the Era of Extracorporeal Shock-Wave Lithotripsy

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