Elderwy AA et al, 2014: Dissolution Therapy versus Shock Wave Lithotripsy for Radiolucent Renal Stones in Children: A Prospective Study
Elderwy AA, Kurkar A, Hussein A, Abozeid H, Hammodda HM, Ibraheim AF
Pediatric Urology Department, Assiut University Hospital, Assiut University, Assiut, Egypt
Pediatric Nephrology Department, Assiut University Hospital, Assiut University, Assiut, Egypt
Radiology Department, Assiut University Hospital, Assiut University, Assiut, Egypt
PURPOSE: We prospectively evaluated the efficacy of dissolution therapy and standard shock wave lithotripsy as a noninvasive modality for radiolucent renal stones in children.
MATERIALS AND METHODS: A total of 87 children with radiolucent renal calculi were included in study. Median age was 2.5 years (range 0.5 to 13). Computerized tomography was done to confirm a stone density of less than 500 HU. Median stone length was 12 mm (range 7 to 24). Patients were randomly divided into 2 groups. The medical group of 48 patients received potassium sodium hydrogen citrate at a dose of 1 mEq/kg per day for 1 to 3 months. The shock wave lithotripsy group of 39 patients were treated with a Lithotripter S (Dornier Medtech, Kennesaw, Georgia) while under general anesthesia. Complications in each group were recorded. Patients were considered stone free when imaging within 3 months showed no evidence of stones.
RESULTS: The stone-free rate was 72.9% for dissolution therapy vs 82.1% after a single session of shock wave lithotripsy (p = 0.314). One patient per group experienced a pyelonephritis episode during followup (p = 0.698). Three of the 13 patients in whom medical regimens failed were noncompliant and 5 ingested the medication sporadically.
CONCLUSIONS: Medical dissolution therapy is a well tolerated, effective treatment for radiolucent renal stones in children. It eliminates the need for shock wave lithotripsy in up to 73% of cases.
J Urol. 2014 May;191(5 Suppl):1491-5. doi: 10.1016/j.juro.2013.10.060. Epub 2014 Mar 26.
PMID:24679880[PubMed - in process]
A good paper. The authors rightly state: "Oral alkalization therapy for uric acid renal stones is established in the literature as an effective, totally noninvasive therapy."
Those 13 patient with chemolysis failure were successfully treated with one (n=11) or 2 (n=1) SWL sessions and URS in one. Based on the authors experience the recommendation to treat uric acid stones in children and adult should be primary oral chemolysis and SWL only in case of failure.