Jee JK et al, 2013: Efficacy of extracorporeal shock wave lithotripsy in pediatric and adolescent urolithiasis
Jee JY, Kim SD, Cho WY
Department of Urology, Dong-A University College of Medicine, Busan, Korea
PURPOSE: To retrospectively evaluate the efficacy of extracorporeal shock wave lithotripsy (ESWL) by age and current condition as a first-line treatment for pediatric and adolescent urolithiasis.
MATERIALS AND METHODS: The computerized records of 55 children were retrospectively reviewed from March 1991 to July 2007. The children were below 18 years of age and had undergone ESWL monotherapy for urolithiasis. There were 36 boys (65.5%) and 19 girls (34.5%), with a mean age of 8.5 years (range, 0.5-18 years). There were 24 patients aged 7 years or less and 31 patients aged more than 7 years.
RESULTS: The mean size of the stones was 9.48 mm (range, 4-22 mm). The overall success rate of ESWL was 90.9% (50 children). The mean number of ESWL sessions was 2.02 (range, 1-10). The mean number of ESWL sessions for the patient group aged 7 years or less was 1.16 (range, 1-2) and that for the patient group aged more than 7 years was 2.97 (range, 1-10; p=0.037). There was also a statistically significant difference in the mean number of ESWL sessions between the younger and older patients who needed general anesthesia (1.16 vs. 2.2 sessions, respectively; 0.042).
CONCLUSIONS: In the patient group aged 7 years or less, the number of ESWL sessions and the complication rate were comparable with those for endoscopic management. Thus, ESWL is an effective first-line treatment modality for patients aged less than 7 years.
Korean J Urol. 2013 Dec;54(12):865-9. doi: 10.4111/kju.2013.54.12.865. Epub 2013 Dec 10.
In this report of SWL results in 50 paediatric and adolescent patients the overall success rate was approximately 91%. Although the mean stone diameters in patients with age ≤ 7 years and > 7 years were 10.2 and 8.9 mm, respectively, the mean number of sessions in the two groups was 1.16 and 2.97. The authors also showed in a diagram that whereas most patients ≤ 7 years were successfully treated with one session (83%), only 10 (32%) of the older children were successfully treated with one session. It can be assumed that the methods for pain relief during SWL had a significant influence on this outcome. Although occasional children in the older age group certainly can be treated without general anaesthesia, the treatment in terms of repeated sessions is likely to be much higher in those who had less powerful pain relief. Probably, in the children that were treated with only sedation, the reaction by the child rather than the behaviour of the stone might have determined the treatment settings and course. It is stated by the authors that there also was a higher re-treatment rate in those children > 7 years who required general anaesthesia, but is not shown how this requirement was defined and applied clinically. Possibly one session was interrupted in order to plan for a second one with anaesthesia.
I agree with the authors that SWL without general anaesthesia is a great advantage of the SWL method, but for children it is at least my own experience, that in the vast majority, treatment during general anaesthesia results in a much higher success rate and lower need of repeated treatment sessions.