Habib EI et al, 2012: Effect of size and site on the outcome of extracorporeal shock wave lithotripsy of proximal urinary stones in children
Habib EI, Morsi HA, Elsheemy MS, Aboulela W, Eissa MA
Division of Pediatric Urology, Aboul-Riche Children's Hospital, Cairo University, Cairo, Egypt
OBJECTIVE: To determine the effect of location and size of stones on the outcome of extracorporeal shock wave lithotripsy (ESWL) in children.
PATIENTS AND METHODS: In 2008-2010, 150 children (median age 6.6 years) with radio-opaque ureteric and renal stones measuring ≤4 cm were treated. Exclusion criteria were coagulation disorders, pyelonephritis, distal obstruction, non-functioning kidney and hypertension. ESWL was performed under general anesthesia. Follow up period was 5-22 months.
RESULTS: 186 stones were treated: 76 calyceal, 92 pelvic and 18 proximal ureteral. Mean stone size was 1.3 cm. A total of 312 sessions were performed (mean per stone = 1.67 sessions). The mean number of shock waves per session was 2423.68. Overall stone-free rate was 89.24%. Having a calyceal location did not significantly affect the stone-free rate (p = 0.133). The failure rate was significantly higher (66.7%) in stones >3 cm in size (p < 0.001). Complications were encountered in 18 patients; 2 underwent auxillary ureteroscopy and 4 uretrolithotomy for treatment of steinstrasse.
CONCLUSION: ESWL is a safe and effective method for treatment of stones up to 2 cm in children. Rate of auxillary procedures increases in stones >2 cm in size. About 80% of failures were associated with stone size >1.35 cm while 52.3% of completely cleared stones were associated with size
Copyright © 2012 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.
J Pediatr Urol. 2012 Jun 11. [Epub ahead of print]
PMID: 22695376 [PubMed - as supplied by publisher]
"Auxillary ureteroscopy and uretrolithotomy were done in two and four patients respectively for steinstrasse extraction, ...four patients had stones that failed to respond to ESWL. These stones were extracted by percutaneous nephrolithotomy." This is a 6, 6 % auxiliary procedure rate. Although the abstract seems to suggest that 1, 35 cm is a critical stone size the failure rate, number of sessions and auxiliaries had a steep increase with stones above 2 cm in diameter.