Abid AF et al., 2019: Factors that affect outcome of pediatric shock waves lithotripsy with sedoanalgesia
Abid AF, Hussein NS, Mahdi BA
Department of Urology, Medical College, Al Yarmouk Hospital, Al-Mustansiriyah University, Baghdad, Iraq.
Introduction: Performing shock wave lithotripsy (SWL) under intravenous sedoanalgesia and the ability to predict the effectiveness of SWL is essential in determining the most appropriate treatment for patients. Patients and Methods: This study consisted of 56 children aged between 1 and 16 years mean age 6.7 ± 4.3 years with renal and ureteric stones who underwent SWL. Incomplete child data were excluded from the study, leaving 47 patients. The procedure was performed under sedoanalgesia with diazepam and ketamine was given intravenously during SWL session. We study the effect of the following factors (age, site, size, opacity of stone, degree of pelvicalyceal dilation, previous urological surgery, number of shock waves, and number of sessions) on stone clearance after SWL. Results: Forty-seven children range from 1 to 16 years, mean age 6.7 ± 4.3 years. There were 39 (83%) with renal stone and 8 (17%) with ureteric stone. The mean size of stone was 12.2 ± 4.4 mm ranging 6-25 mm. Of 47 children, 36 (76.6%) were stone-free. Age below 6 years, pelvic stones, children without surgery, number of shock waves, and number of sessions were significant factors that affect the stone-free rate after SWL, while the stone size, opacity, and calyceal system dilatation were not statistically significant factors. Conclusions: The present analysis shows that stone-free status for children with urolithiasis depends on the age of presentation, previous history of ipsilateral stone treatment, stone location, and number of sessions. Pediatric lithotripsy under intravenous sedoanalgesia is feasible, general anesthesia is not mandatory, and any anesthetic complications were not encountered.
Urol Ann. 2019 Jan-Mar;11(1):72-76. doi: 10.4103/UA.UA_81_17. FREE ARTICLE
How to treat children with urolithiasis is a matter of debate. The common opinion is that children cannot be treated with SWL without general anesthesia and under these circumstances it is essential to reduce the need of repeated session. For that reason, it has been recommended that more invasive treatment modalities should be preferred. My own personal experience over the years is, however, that very few children have required repeated SWL session.
This report comprises 47 patients with an age range between 1 and 16 years and treated with SWL with only analgesics and sedatives: diazepam and ketamine.
It is not stated if these children were part of a consecutive series of stone removal or if some kind of selection had been carried out. Nevertheless, the observations are interesting.
The major message from this article, in addition to the possibility of avoiding general anesthesia, is that the best results were recorded in the youngest children ( 6 years). Moreover, almost 85% of the children had their stones completely disintegrated with only one SWL session. All children had been treated with a Siemens lithotripter.