Paediatric ureteric calculi: efficacy of primary in situ extracorporeal shock wave lithotripsy

Abstract

Objective To evaluate the efficacy of primary in situ extracorporeal shockwave lithotripsy (ESWL) for the treatment of ureteric calculi in children. Patients and methods The Wolf 2500 Piezolith was used to treat 63 children (aged 4 months to 12 years) with 76 ureteric calculi, including 10 children with impacted calculi. The calculi were located in 14 upper, 13 mid and 44 lower ureters, and the stone burden varied from 4 to 17.8 mm (mean 12.6). All children aged ≤10 years were treated under general anaesthesia; lithotripsy was attempted under intravenous sedation in the older children. Results At the 3‐month follow‐up, there was an overall successful outcome in 55 children (87%), which included 12 of 13, eight of nine (89%) and 35 of 41 (85%) of the children with upper, mid and lower ureteric calculi, respectively, and nine of the 10 with impacted calculi. Re‐treatment was required in 20 (36%) patients, while auxiliary procedures after ESWL were required in three (6%). The major complications encountered were ureteric obstruction with sepsis in two children, bacteraemia in another and urinary retention due to a urethral stone fragment in a fourth child. Conclusions In situ ESWL was an effective treatment modality for ureteric calculi at all levels in children, even when impacted. In the short term, complications were minimal, but the long‐term effects need further assessment.

Ureteric calculi in children: preliminary experience with holmium:YAG laser lithotripsy

“…The mean (range) duration of the procedure was 72 (45-125) min, of fluoroscopy was 17 (13-58) s and of hospital stay was 3.8 (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14) days. Of the 28 ureteroscopies, 17 (61%) required mechanical dilatation of the ureteric orifice before negotiating the 8 F ureteroscope into the intramural ureter.…”

“…Between June 1999 and January 2003, 26 children with ureteric calculi underwent ureteroscopy and Ho:YAG laser lithotripsy at our institution (14 boys and 12 girls, mean age 6.5 years, range [2][3][4][5][6][7][8][9][10][11][12]. The presenting symptoms were colicky abdominal pain in 16 (62%), LUTS in five (19%), acute obstruction with sepsis in four (15%) and haematuria in one (4%) child.…”

Litotripsia extracorpórea por ondas de choque en niños. A propósito de un caso complicado

“…Anteriormente se recomendaba proteger el pulmón para evitar el trauma a ese órgano [3][4][5] . En la actualidad se recomienda la protección durante la litotropsia de cálculos ureterales bajos en niñas, para evitar el daño a los ovarios 3,6 .…”

The surgical management of stones in children

“…Another indication for ESWL is ureteric calculi, particularly in the upper and lower ureter, which will not pass spontaneously [26,27]. However, as potential damage to the ovarian germ cells cannot be excluded, avoiding ESWL in girls with lower ureteric stones is recommended.…”