Gündüz M et al, 2016: Do JJ Stents Increase the Effectiveness of Extracorporeal Shock Wave Lithotripsy for Pediatric Renal Stones?
Gündüz M, Sekmenli T, Ciftci İ, Elmacı AM.
Department of Pediatric Surgery, Selcuk University Medical Faculty, Konya, Turkey.
PURPOSE: We aimed to evaluate the effects of preoperative urinary catheterization in nephrolithiasis treatment with extracorporeal shock wave lithotripsy (SWL).
METHODS: Patients admitted to the Department of Pediatric Surgery for renal stones between June 2012 and June 2014 were evaluated retrospectively. Patients were divided into 2 groups based on JJ stent placements. Group 1 did not receive JJ stents, while group 2 did. The recorded demographic data for each group included age, gender, stone size, location, sessions, and complications. The Elmed Complit ESWL system was used with 11-13 kV, and 1,000-1,200 shots in patients 2-4 years of age, and 11-14 kV, and 1,000-1,500 shots for patients over 4 years.
RESULTS: In group 1, 18 sessions of SWL were performed on 8 female and 2 male children with a mean age of 4.5 (range 2-12) years and stone diameter of 9 (range 7-15) mm. The locations of the renal stones were in the upper pole in 1 patient, 7 in the lower pole, and 2 in the pelvis renalis. Postoperatively, 1 patient had hematuria, 2 had dysuria, and one had a stone in the external urethral meatus. Eighty percent of patients were stone free; there were no fragmentations in 2 patients, and 1 patient discontinued treatment. In group 2, 15 SWL sessions were performed on 5 female and 5 male children aged 4 (range 3-5) and the stone diameter was 9 (range 7-16) mm. The locations of the renal stones were in the upper pole in 6 patients, in the lower pole in 3 patients, and in the ureteropelvic junction in one patient. JJ stents were placed in all patients preoperatively. Postoperatively, 3 patients had hematuria and one had dysuria. At the end of the study, all of the patients were stone free. Statistically, there were no differences in age, gender, stone size, location, and the number of sessions.
CONCLUSIONS: Our results indicate that SWL without preoperative ureteral stenting is an effective and safe procedure that can be carried out in the pediatric population. Preoperative JJ stenting is unnecessary in patients, especially in those with smaller stone diameters.
Urol Int. 2016 Oct 26. [Epub ahead of print]
It has been demonstrated repeatedly that stents often are unnecessary in children. The reason is that children have a much more powerful ureter than is the case in adults. The two groups of children included in this retrospective study had been treated for relatively small stones; all with a longest diameter of not more than 16 mm. Group 1 was treated without and Group 2 with JJ-stents.
It is thus not surprising that both groups were successfully treated. Stone-free rates in Groups 1 and 2 were 80 and 100%, respectively. The results support previous observations that SWL can be carried out safely in most children without a stent. Special considerations might be necessary when larger stones are planned for SWL.