Jia J et al, 2012: Extracorporeal shock wave lithotripsy is effective in treating single melamine-induced urolithiasis in infants and young children
Jia J, Shen X, Wang L, Zhang T, Xu M, Fang X, Xu G, Qian C, Wu Y, Geng H.
Department of Pediatric Urology, Xinhua Hospital, Shanghai Jiao tong University School of Medicine, Shanghai, China; Children's Urolithiasis Treatment Center of Chinese Ministry of Health, Shanghai China
PURPOSE: To evaluate the efficacy of extracorporeal shock wave lithotripsy (ESWL) in treating infant melamine-induced single urolithiasis.
MATERIAL AND METHODS: Between March 2009 and July 2010, 189 infants and young children with single melamine-induced urolithiasis were referred to our center for treatment by ESWL. There were 17 patients with proximal ureteric calculi, 5 with mid-ureteric calculi, 26 with distal ureteric calculi and 141 with renal calculi. The stone size ranged from 3.8mm to 25mm（with a mean size of 9.79±3.83 mm.
RESULTS: All the patients underwent ESWL using the same device with an energy ranging from 8 KV to 12 KV. The stone-free rate, clinical insignificant residual fragment rate and retreatment rate were 97.88%, 1.59% and 2.65%, respectively. One hundred and eighty (95.24%) patients required only one ESWL session and 5 (2.65%) patients required two sessions. The mean number of shocks delivered per session was 580.36±190.69 (ranging 65 to 950). ESWL failed to fragment stones in only one infant, who had a proximal ureteral stone. Totally 181 specimens were collected and were analyzed by infrared spectrum. The results showed that the main composition was uric acid and melamine. All the patients were followed for a mean period of 28 months (ranging 20-36 months). No severe complications, such as renal subcapsular hemorrhage, hypertension, kidney ruptured, or lung injury were observed.
CONCLUSIONS: ESWL with low energy can effectively disintegrate melamine-induced calculi. It has become our preferred method for single melamine-induced urolithiasisin infants and young children.
J Urol. 2012 Nov 27. doi:pii: S0022-5347(12)05618-2. 10.1016/j.juro.2012.11.109. [Epub ahead of print]
PMID: 23201375[PubMed - as supplied by publisher]
This is a report of results of SWL carried out in 189 children with uric acid/melamine stones. Stone localization was carried out by means of ultrasound. The stone-free rate of 98 % is indeed impressive particularly in view of the small number of shock waves, the low energy levels (8-12 kV) and by the fact that as many as 25 % of the stone were located in the ureter; five in the mid ureter. Although it is mentioned that all patients had received some form of medical treatment before SWL it is not commented if that medication could have contributed to the high stone-free rates with only one session.