Extracorporeal shock wave lithotripsy in children: equivalent clearance rates to adults is achieved with fewer and lower energy shock waves

Abstract

age 5.9 [4.4] years) and group B of 562 adults (mean [ SD ] age 40.9 [13.1] years). The number and energy of SWs used was not predetermined and was tailored until adequate fragmentation was achieved. Initial stone reassessment was performed at 48 h and monthly thereafter. The number of SWs, intensity of SWs, stone-free rate, auxiliary procedure rate, re-treatment rate, complication rate and effectiveness quotient (EQ) were assessed in each group. RESULTSThe stone-free rate with ESWL was 84% in children and 87% in adults ( P = 0.78). The EQ was 77% and 75% in children and adults, respectively ( P = 0.56). The mean ( SD ) number of SWs and energy required per session was 950 (349) and 11.83 (0.48) kV in children and 1262 (454) and 12.36 (0.34) kV in adults ( P < 0.001). The re-treatment, auxiliary procedure and complication rates were similar in both groups. CONCLUSIONESWL is as safe and effective in children as in adults for solitary renal and upper ureteric stones that are < 2 cm. Children required significantly fewer and lower energy SWs to achieve equivalent results. KEYWORDS adult, children, ESWL, urolithiasisStudy Type -Therapy (case series) Level of Evidence 4 OBJECTIVETo compare the outcome, safety and efficiency of extracorporeal shock wave lithotripsy (ESWL) using an electromagnetic lithotripter for upper urinary tract stones in children and adults. PATIENTS AND METHODSWe retrospectively reviewed data over a 5-year period for patients with solitary, renal and upper ureteric stones measuring < 2 cm in whom ESWL was the treatment method. Group A consisted of 44 children (mean [ SD ]

Minimally invasive approaches and their efficacy in pediatric urolithiasis

“…[8][9][10][11][12] Management of stone disease with ESWL was firstly reported in 1986 by Newman et al [13] As is the case with adult patients, in pediatric patients ESWL is accepted to be the firstline treatment alternative in the management of renal stones smaller than 2 cm in diameter. [14][15][16][17] Comparable success rates of ESWL have been reportedly achieved in children, and adults. In various studies performed, success rates have changed between 60, and almost 100 percent, and mainly depend on size, and composition of the stone, and type of the device used.…”

Our experience with percutaneous nephrolithotomy in pediatric renal stone disease

“…[3] Pediatrik hastalarda 2 cm'den küçük renal pelvis taşlarının tedavisinde ilk tercih vücut dışı şok dalga tedavisidir (ESWL). [4][5][6][7] Birçok merkezde başarıyla uygulanmakta ve yüz güldürücü sonuçlar alınmaktadır. Ancak; büyük ve kompleks taşlarda, kırılan taşların dökülmesini engelleyecek anatomik bozuklukların varlığında, sistin gibi sert veya ESWL'nin başarısız olduğu taşlarda ve taş tedavisinin beraberinde düzeltilmesi gereken konjenital anomali varlığında invaziv yöntemlere gereksinim duyulmaktadır.…”

Çocukluk Taş Hastalığında Extracorporeal Shock Wave Lithotripsy: Hala Yaşıyor ve Çok Etkili

“…İlk pediatrik SWL serisini diğer çalışmalar takip etmiş ve 2000'li yıllarda olgu sayıları yüksek seriler yayımlanmıştır (6)(7)(8). Erişkinlerle karşılaştırıldığında SWL'nin daha düşük kilovolt (kV), şok sayısı ve seans sayısı ile çocuklarda benzer başarı oranlarına sahip olduğu bildirilmiştir (9). Çocuklarda uygulanan enerjinin 14-22 kV, seans başına şok sayısının 1800-2000 olması (5 yaş altı çocuklarda ise seans başına 1000 şok dalgasını geçmemesi), en fazla 3 seans uygulanması ve böbreklerde iki seans arasında en az 15 gün geçmesi önerilmektedir (10).…”