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El-Nahas AR et al, 2013: Extracorporeal shockwave lithotripsy for renal stones in pediatric patients: A multivariate analysis model for estimating the stone-free probability

El-Nahas AR, El-Assmy AM, Awad BA, Elhalwagy SM, Elshal AM, Sheir KZ.
Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt


Abstract

OBJECTIVES: To define factorsm affecting the stone-free rate of extracorporeal shockwave lithotripsy in the treatment of pediatric renal calculi, and to establish a regression model for pretreatment prediction of stone-free probability.

METHODS: From January 1999 through February 2012, 207 children with mean age 6.4 ± 3.8 years underwent shockwave lithotripsy with Dornier Lithotripter S for treatment of renal stones. The stone-free rate was evaluated 3 months after the last shockwave lithotripsy session with non-contrast computed tomography. Treatment success was defined as complete clearance of the stones with no residual fragments. Multivariate logistic regression analysis was used to identify independent risk factors and to predict the probability of being stone free.

RESULTS: The mean length of the stone was 11.6 ± 4 mm. The stone-free rate was 71%. Independent factors that adversely affect stone-free rate were increasing stone length and calyceal site of the stone. Relative risks for not being free of stones were 1.123 for stone length, 2.673 for stones in the upper or middle calyx and 4.208 for lower calyx stones.

CONCLUSION: Stone length and location are prognostic factors determining stone-free rate after shockwave lithotripsy for renal calculi in pediatric patients. Based on our analysis, shockwave lithotripsy should be recommended for renal pelvis stones up to 24 mm, upper or middle calyceal stones up to 15 mm and lower calyceal stones up to 11 mm.

Int J Urol. 2013 Feb 26. doi: 10.1111/iju.12132. [Epub ahead of print]
PMID:23441845 [PubMed - as supplied by publisher]

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Comments 1

Hans-Göran Tiselius on Monday, 14 January 2013 06:50

The authors report their experience of SWL in a paediatric population and present some factors that can be used to predict the treatment outcome. Although the stone burden (in study only expressed by the largest diameter of the stone) and stone location are well recognized determinants of SWL results, the outcome in children usually is superior to that in adults. The pre-requisite for that is that the stones are satisfactorily disintegrated. It is of note that in as many as 22% of the children sedatives + analgesics rather than general anaesthesia was used. It is not known if this affected the treatment result, but it is my own experience that in most children it is difficult or impossible to carry out and appropriate SWL without general anaesthesia.

Perhaps the stone-free rates could have been better and the need of repeated treatment sessions reduced by a longer interval between the sessions, because fragment clearance should be much better than what we are used to see in adults. This is an effect of the more powerful ureter in children.

Hans-Göran Tiselius

The authors report their experience of SWL in a paediatric population and present some factors that can be used to predict the treatment outcome. Although the stone burden (in study only expressed by the largest diameter of the stone) and stone location are well recognized determinants of SWL results, the outcome in children usually is superior to that in adults. The pre-requisite for that is that the stones are satisfactorily disintegrated. It is of note that in as many as 22% of the children sedatives + analgesics rather than general anaesthesia was used. It is not known if this affected the treatment result, but it is my own experience that in most children it is difficult or impossible to carry out and appropriate SWL without general anaesthesia. Perhaps the stone-free rates could have been better and the need of repeated treatment sessions reduced by a longer interval between the sessions, because fragment clearance should be much better than what we are used to see in adults. This is an effect of the more powerful ureter in children. Hans-Göran Tiselius
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