Pediatric Staghorn Calculi: The Role of Extracorporeal Shock Wave Lithotripsy Monotherapy With Special Reference to Ureteral Stenting

Purpose: We aimed to evaluate the effects of preoperative urinary catheterization in nephrolithiasis treatment with extracorporeal shock wave lithotripsy (SWL). Methods: Patients admitted to the Department of Pediatric Surgery for renal stones between June 2012 and June 2014 were evaluated retrospectively. Patients were divided into 2 groups based on JJ stent placements. Group 1 did not receive JJ stents, while group 2 did. The recorded demographic data for each group included age, gender, stone size, location, sessions, and complications. The Elmed Complit ESWL system was used with 11-13 kV, and 1,000-1,200 shots in patients 2-4 years of age, and 11-14 kV, and 1,000-1,500 shots for patients over 4 years. Results: In group 1, 18 sessions of SWL were performed on 8 female and 2 male children with a mean age of 4.5 (range 2-12) years and stone diameter of 9 (range 7-15) mm. The locations of the renal stones were in the upper pole in 1 patient, 7 in the lower pole, and 2 in the pelvis renalis. Postoperatively, 1 patient had hematuria, 2 had dysuria, and one had a stone in the external urethral meatus. Eighty percent of patients were stone free; there were no fragmentations in 2 patients, and 1 patient discontinued treatment. In group 2, 15 SWL sessions were performed on 5 female and 5 male children aged 4 (range 3-5) and the stone diameter was 9 (range 7-16) mm. The locations of the renal stones were in the upper pole in 6 patients, in the lower pole in 3 patients, and in the ureteropelvic junction in one patient. JJ stents were placed in all patients preoperatively. Postoperatively, 3 patients had hematuria and one had dysuria. At the end of the study, all of the patients were stone free. Statistically, there were no differences in age, gender, stone size, location, and the number of sessions. Conclusions: Our results indicate that SWL without preoperative ureteral stenting is an effective and safe procedure that can be carried out in the pediatric population. Preoperative JJ stenting is unnecessary in patients, especially in those with smaller stone diameters.

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“…Al-Busaidy et al [13] treated 42 children with staghorn stones using SWL. They observed no complications in those patients who were stented.…”

Section: Discussionmentioning

confidence: 99%

Do JJ Stents Increase the Effectiveness of Extracorporeal Shock Wave Lithotripsy for Pediatric Renal Stones?

et al. 2016

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“…Higher success rates have been achieved in the treatment of smaller stones.A renal pelvis stone smaller than 2 cm in diameter will be an ideal choice for ESWL treatment. [18][19][20][21][22][23] Dimensions, location, and composition of the stone, anatomy of the renal calyx, superposition of bone on ureter are the most important factors effecting success rates of ESWL.…”

Section: Discussionmentioning

confidence: 99%

Minimally invasive approaches and their efficacy in pediatric urolithiasis

Altıntaş

Beytur

Oğuz

et al. 2013

Turkish Journal of Urology

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Objective: We compared the frequency of usage and success of minimally invasive approaches in the management of pediatric urolithiasis in our clinic. Material and methods:Data from pediatric patients (≤16 years of age) who had undergone percutaneous nephrolithotomy (PNL), ureterorenoscopy (URS), and extracorporeal shock wave lithotripsy (ESWL) between January 2001 and December 2011 were retrospectively investigated. Results:In this study, 415 pediatric patients, who were treated for 291 renal, and 124 ureteral stones, were evaluated. The patients were treated with PNL (n=148; 82 boys, 66 girls), URS (n=99; 58 boys, and 41 girls) or ESWL (n=168; 91 boys, and 77 girls). The mean patient ages were 7.3 (1-16), 9.1 (1-16), and 8.8 (1-16) years in the PNL, URS, and ESWL groups, respectively. The stone-free rates after treatment with PNL, URS, and ESWL were 77, 83.8 and 88.7%, respectively. Conclusion:It is important that selected therapies are properly planned, and the use of minimally invasive approaches is important in pediatric patients due to potentially high recurrence rates. Currently, ESWL, PNL and URS are performed with high success rates for the treatment of stones, and open surgery is rarely used due to the success obtained with minimally invasive approaches.

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“…Stone-free rates of 67-93 % in short-term and 57-92 % in long-term followup studies have been reported [4,17,18]. Consequently, ESWL can be indicated in children with a larger stone volume, and the placement of a ureteral stent before or after ESWL is generally unnecessary [18,[20][21][22][23][24][25]. The mean number of shock waves for each treatment is about 1,800 and 2,000 (up to 4,000 if needed) and the mean power set varies between 14 and 21 kV.…”

Section: Conservative Management Of Acute Stone Episodementioning

confidence: 99%

“…A general recurrence rate of 2-44 % has been reported for children after ESWL; the residual stone growth is between 23 and 33 % [17,22,24,25]. In contrast, the recurrence rate in adults is only between 8 and 10 %, and the residual stone growth averages 22 %.…”

Section: Conservative Management Of Acute Stone Episodementioning

confidence: 99%

“…Since placement of the internal stents upon ESWL does not improve free pass of the fragments routine stenting does not recommend prior to the ESWL session [4,24]. However, if the stent has been planned to be placed during ESWL treatment we prefer to use the stents with an attached string, which eliminates the need for the additional anaesthesia and allows the stent removal without cystoscopy.…”

Section: Conservative Management Of Acute Stone Episodementioning

confidence: 99%

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Current management of paediatric urolithiasis

Gnessin

Chertin

2012

Pediatr Surg Int

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We aimed to review a current management of paediatric nephrolithiasis. The current literature, including our own experience on the treatment of paediatric nephrolithiasis was reviewed by MEDLINE/PubMed search. We have used in our search following keywords: urolithiasis, nephrolithiasis, paediatrics, surgical treatment, conservative management, ESWL, ureteroscopy, and open renal surgery. The search was limited to the English language literature during the period of time from 1990 to 2011. All papers were reviewed independently by all co-authors and only the manuscripts directly related to the reviewed subjects were included into the current review. Due to the high incidence of predisposing factors for urolithiasis in children and high stone recurrence rates, every child with urinary stone should be given a complete metabolic evaluation. Most stones in children can be managed by ESWL and endoscopic techniques. Paediatric stone disease is an important clinical problem in paediatric urology practice. Because of its recurrent nature, every effort should be made to discover the underlying metabolic abnormality so that it can be treated appropriately. Obtaining a stone-free state with interventional management and close follow-up are of utmost importance.

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Pediatric Staghorn Calculi: The Role of Extracorporeal Shock Wave Lithotripsy Monotherapy With Special Reference to Ureteral Stenting

Abstract: ESWL monotherapy was an efficient and safe modality for the treatment of staghorn calculi in children. Stented patients had fewer major complications and a shorter hospital stay. Prophylactic ureteral stenting is advisable before ESWL for staghorn calculi in children.

Cited by 48 publications

References 17 publications

Do JJ Stents Increase the Effectiveness of Extracorporeal Shock Wave Lithotripsy for Pediatric Renal Stones?

Do JJ Stents Increase the Effectiveness of Extracorporeal Shock Wave Lithotripsy for Pediatric Renal Stones?

Minimally invasive approaches and their efficacy in pediatric urolithiasis

Current management of paediatric urolithiasis

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