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Goktas C et al, 2011: SWL in Lower Calyceal Calculi: Evaluation of the Treatment Results in Children and Adults

Goktas C, Akca O, Horuz R, Gokhan O, Albayrak S, Sarica K
Kartal Training and Research Hospital, Department of Urology, Istanbul, Turkey


Abstract

OBJECTIVE: To evaluate the treatment parameters of shockwave lithotripsy (SWL) in lower calyceal calculi in adults and children in a comparative manner.

MATERIAL AND METHODS: Between 2006 and 2011, SWL was performed for lower calyceal calculi in 282 adults (mean age 48.5 years, range 28-64) and 54 children (mean age 48 months, range 5-141). The Wolf Piezolith 3000 lithotriptor has been used for SWL. Success rates, auxiliary procedures, additional interventions, and complications were evaluated in detail in a comparative manner.

RESULTS: Mean stone size was 7.7 mm (range 5-25) and 8.1 mm (range 5-23) in children and in adults, respectively. Mean SWL sessions were 1.5 (range 1-5) in children and 2.4 (range 1-6) in adults. Although 66.6% of children were stone-free after the first session, 28% of adult patients were stone-free after the first SWL session, showing a statistically significant difference (P = .0001). After the treatments, although a complete stone-free status was obtained in 85% of children, 31.5% of adults were stone-free at 3-month follow-up after SWL (P = .0001). Although no auxiliary procedures were needed in children, 8.2% of adults required them. Likewise, the percentage of additional procedures were higher in adults than children (20.2%).

CONCLUSION: SWL for lower calyceal calculi has been found to be highly successful in pediatric patients. These results demonstrate that, irrespective of stone size, SWL should be the first treatment alternative in the management of lower calyx stones in children.

Copyright © 2011 Elsevier Inc. All rights reserved.
Urology. 2011 Dec;78(6):1402-6. doi: 10.1016/j.urology.2011.08.005. Epub 2011 Oct 2PMID: 21962877 [PubMed - as supplied by publisher]

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Comments 1

Peter Alken on Friday, 12 August 2011 15:21

This paper documents again that SWL in children yields better results than in adults. The authors join the arguments previously given: SWs are transmitted with lower loss of energy through the small body volume of a child and the shorter length of the child's ureter which is more elastic and distensible permits easier transmission of stone fragments and prevents ureteral impaction. Unfortunately this and other publication on SWL in children fail to give data on the stone composition which would allow to conclude that the "young =brittle?" stones of young patients respond better to SWL. Nevertheless the authors recommendation "SWL should always be accepted as the preferred treatment options in all children with lower-pole stones 1-2.5 cm" can be broadened to include stones in any area of the urinary tract of children.

Peter Alken

This paper documents again that SWL in children yields better results than in adults. The authors join the arguments previously given: SWs are transmitted with lower loss of energy through the small body volume of a child and the shorter length of the child's ureter which is more elastic and distensible permits easier transmission of stone fragments and prevents ureteral impaction. Unfortunately this and other publication on SWL in children fail to give data on the stone composition which would allow to conclude that the "young =brittle?" stones of young patients respond better to SWL. Nevertheless the authors recommendation "SWL should always be accepted as the preferred treatment options in all children with lower-pole stones 1-2.5 cm" can be broadened to include stones in any area of the urinary tract of children. Peter Alken
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