Adanur S et al, 2014: Extracorporeal shockwave lithotripsy under sedoanalgesia for treatment of kidney stones in infants: a single-center experience with 102 cases.
Adanur S, Ziypak T, Yılmaz AH, Kocakgol H, Aksoy M, Yapanoglu T, Polat O, Aksoy Y
Department of Urology, School of Medicine, Ataturk University, 25240, Erzurum, Turkey.
OBJECT: We present the efficacy of shockwave lithotripsy (SWL) therapy administered with sedoanalgesia in infants with kidney stones. MATERIALS AND METHODS: We enrolled 102 patients aged 5-24 months who had kidney stones and received SWL therapy under sedoanalgesia using a Siemens Lithostar Modularis device. Patient and stone characteristics, therapy parameters, pain score, complications,
discharge time, and follow-ups were registered and evaluated. Pain score was assessed using a Neonatal Infant Pain Score (NIPS). Postanesthetic discharge scoring system (PADSS) was used for the assessments of postprocedural discharge procedure. RESULTS: Mean age of the patients was 17.2 ± 6.3 months (5-24 months). Mean stone size was 7.9 ± 3.3 mm (5-23 mm). The most common concomitant metabolic disorders were hypercalciuria and hypocitraturia. The stone-free rates of the infants were 70.6, 87.3, and 99.1 % after the first, second, and third sessions of SWL therapy, respectively. The mean NIPS scores procedure during, and at 1 h after SWL procedure were determined as 0.24 ± 0.45 and 0.34 ± 0.47, respectively. There was no statistically significant difference between two pain score values (P = 0.114). The mean discharge time of patients after the SWL procedure were 108.6 ± 27.9 min. Forty-two patients (41.1 %) were followed
up. The follow-up period varied between 8 and 48 months (mean 19.5 months); none of those patients showed evidence of diabetes mellitus, hypertension, or renal function impairment. CONCLUSIONS: SWL therapy under sedoanalgesia is a safe and efficient treatment modality that can be administered with low complication rates and high stone-free rates in the treatment of renal stones in infants.
Int Urol Nephrol. 2014 Jul 31. [Epub ahead of print]
Good results and no problems!?
“… to our knowledge, SWL therapy administered with intravenous sedation has not been reported in infants. Therefore, our study is the first and only study in the literature to be conducted on this topic with the largest series in one center.”
Who treats children with ESWL should discuss the sedation technique with his anaesthetist.