Abstract

Abstract

PURPOSE: We determined the safety, efficacy and complications of extracorporeal shock wave lithotripsy in managing pediatric urolithiasis and analyzed possible factors affecting the complication rate.

MATERIALS AND METHODS: We retrospectively reviewed 128 patients younger than 16 years who had undergone extracorporeal shock wave lithotripsy with a Lithostar® lithotripter between January 2000 and December 2010. Stone clearance and complications were assessed at postoperative week 1, and months 1 and 3. Success was defined as no radiological evidence of stone, or fragments 4 mm or less. Treatment failure was analyzed to find any correlation with stone size. Complications were assessed with a specific focus on rehospitalizations during postoperative week 1.

RESULTS: The overall success rate was 93.5% (115 of 123 patients). Repeat treatment rate was 56.1% (69 patients). Extracorporeal shock wave lithotripsy failed in 8 children, who subsequently required ancillary procedures. Mean stone size in the treatment failure group was 17.03 mm, compared to 13.04 mm in the successfully treated group. A total of 22 patients (17.8%) had complications in postoperative week 1 but only 19 (15.4%, 12 boys and 7 girls) were rehospitalized at that time. Presence of a metabolic risk factor was the only predictive factor for complications. By comparison, we found a lower success rate and higher ancillary procedure rate in the group with complications.

CONCLUSIONS: Extracorporeal shock wave lithotripsy is effective for pediatric urolithiasis, with a small but substantial morbidity rate. Parents should be informed about possible rehospitalization following extracorporeal shock wave lithotripsy due to complications independent of stone size.

Copyright © 2012 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

J Urol. 2012 May;187(5):1812-6. doi: 10.1016/j.juro.2011.12.092. Epub  2012 Mar 16

PMID: 22425045 [PubMed - in process]

Comment

Comment

The report summarizes the authors' experience of ESWL carried out in 128 children (age children the total number of shockwaves was ≤ 1000 and for older children ≤ 2500. There was a high success rate of 93.5%; stone-free rate 74% with an average of 1.6 sessions.

The complications that required hospitalization, the main subject of the article, occurred in 15% (n=12) in which children steinstrasse was recorded in 5.

Hans-Göran Tiselius