Göktaş C et al, 2012: Does Child's Age Affect Interval to Stone-free Status After SWL? A Critical Analysis

Wednesday, 28 December 2011

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Göktaş C, Akça O, Horuz R, Gökhan O, Albayrak S, Sarica K
Kartal Training and Research Hospital, Urology Department, Istanbul, Turkey

Abstract

OBJECTIVE: To evaluate the success rates and complications of extracorporeal shock wave lithotripsy (ESWL) in children with renal stones in an age-dependant manner.

METHODS: From 2006 to 2010, 164 children (male/female ratio 1:3) with renal calculi have been treated with ESWL (PiezoLith3000 lithotripter). The children were divided into 2 age groups: group 1, 0-6 years old (n = 133); and group 2, 7-15 years (n = 31). The patient- and treatment-related parameters were recorded for comparative evaluation. The success of ESWL in terms of the stone-free rates, additional procedures, and complications were comparatively evaluated. The data were analyzed statistically.

RESULTS: The mean age of groups 1 and 2 was 28 ± 18 months (range 4-71) and 119 ± 28 months (range 73-178), respectively. Although general anesthesia was used for all patients in group 1, 29% of the patients were treated under neuroleptic anesthesia in group 2. During the 3-month follow-up period, the complete stone-free rate was 94.7% (126 of 133), and treatment was unsuccessful in 7 patients (5.3%) in group 1. The corresponding data were 87% (27 of 31; P = .222) and 4 (13%; P = .089) in group 2. The stone-free rate after the first session was 67.6% (90 of 133) and 38.7% (12 of 31) in groups 1 and 2, respectively (P = .004). The mean number of ESWL sessions applied was 1.6 (range 1-5) and 2.9 (range 1-6) in groups 1 and group 2, respectively (P = .0001). No major complications were noted.

CONCLUSION: Our results have demonstrated that ESWL is highly successful in the management of renal calculi in children. Compared the outcomes by age, the younger children become stone free more quickly than the older children with fewer ESWL sessions.

Comments 1

Hans-Göran Tiselius on Wednesday, 28 December 2011 07:46

Interestingly younger children became stone-free faster than older children. Piezoelectric disintegration was used. The fact that the youngest children (1-6 years) had a faster clearance of stones than the older children (7-15 years) might reflect differences in propulsive power of the collecting system. On the other hand the higher rate in the youngest children after one ESWL session is probably more related to different stone size and stone location. There is no information on stone composition, but can be assumed that the content of calcium oxalate monohydrate increases with increased age as a result of conversion from calcium oxalate dihydrate to calcium oxalate monohydrate. The overall stone-free rate of 95% is, however, excellent.

Hans-Göran Tiselius