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Basuguy E. et al., 2023: Effectiveness of extracorporeal shock wave lithotripsy in urolithiasis patients under 2 years of age.

Basuguy E, Önen A, Azizoğlu M, Okur MH, Aydoğdu B, Arslan S.
Department of Pediatric Surgery, Medical Faculty of Dicle University, Diyarbakir.
Department of Pediatric Surgery, Balıkesir University Medical School, Balıkesir. Turkey.

Abstract

Objective: In this study, we present our extracorporeal shock wave lithotripsy (ESWL) outcomes in urolithiasis patients under the age of two.

Materials and methods: The procedure was performed with patients < 2 years of age sedated, under anesthesia using ketamine and Dormicum (midazolam), in the supine position. Fragmentation was evaluated by fluoroscopy after the procedure.

Results: A total of 74 procedures were performed on 65 kidneys. One patient with bilateral stones had two sessions of ESWL on the right side; three sessions of ESWL were performed in one patient with a unilateral stone, and two sessions were performed in seven patients with unilateral stones. All other patients underwent one session of ESWL. As post-procedural complications, hematuria was observed in 14 patients (12 mild and 2 significant), and vomiting occurred in 1 patient. Ureterorenoscopy was performed in 5 patients, and percutaneous nephrolithotomy in 6 patients due to a failed procedure.

Conclusion: As a result, ESWL treatment is effective and has advantages such as a short hospitalization time, good reproducibility, cost-effectiveness, and a low rate of complications. Therefore, we recommend ESWL as the first-line treatment for renal and proximal ureteral stones in infants < 2 years of age.

Cir Cir. 2023;91(5):620-626. doi: 10.24875/CIRU.22000548. PMID: 37844884 English. FREE ARTICLE

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Comments 1

Peter Alken on Wednesday, 08 May 2024 11:00

Exceptional from other papers on EWSL is that renal szintigraphy was performed to investigate renal damage after EWSL. But the data are weak. When sonography showed - not specified - renal damage in 11 of 65 kidneys, impaired renal parenchymal structure and reduced function were observed in all 11 patients undergoing scintigraphy.
Not clear why they correlated the damage with 5 risk factors: gender, age, side, location and stone size, but not number of shots or applied energy.
I think the data presented show no solid basis for their recommendation: “As binary logistic regression analysis report marked the stone size as a risk factor for renal damage, stones larger than 11,5 mm have the potential to develop renal damage. Thus, we recommend revealing DMSA scanning in patients at risk for renal damage such as stones larger than 11.5 mm.

Peter Alken

Exceptional from other papers on EWSL is that renal szintigraphy was performed to investigate renal damage after EWSL. But the data are weak. When sonography showed - not specified - renal damage in 11 of 65 kidneys, impaired renal parenchymal structure and reduced function were observed in all 11 patients undergoing scintigraphy. Not clear why they correlated the damage with 5 risk factors: gender, age, side, location and stone size, but not number of shots or applied energy. I think the data presented show no solid basis for their recommendation: “As binary logistic regression analysis report marked the stone size as a risk factor for renal damage, stones larger than 11,5 mm have the potential to develop renal damage. Thus, we recommend revealing DMSA scanning in patients at risk for renal damage such as stones larger than 11.5 mm. Peter Alken
Friday, 12 July 2024