Mandal S et al, 2012: Comparison of extracorporeal shock wave lithotripsy for inferior caliceal calculus between children and adults: a retrospective analysis-why do results vary?
Mandal S, Sankhwar SN, Singh MK, Kathpalia R, Singh V, Goel A, Singh BP, Dalela D.
Department of Urology, Chhatrapati Shahuji Maharaj Medical University, formerly King George Medical College, Lucknow, India
OBJECTIVE: To retrospectively evaluate the effectiveness of extracorporeal shock wave lithotripsy (ESWL) for inferior caliceal calculi 20 mm in size and compare the results between children and adults.
MATERIALS AND METHODS: From January 2004 to January 2012, ESWL was performed for inferior caliceal calculi in 230 children and 1006 adults. The Dornier compact alpha-K1025163 (Dornier Med Tech) was used. The success rates, number of ESWL sessions required, and auxiliary procedures used were evaluated in a comparative manner.
RESULTS: The overall stone-free rate (for both stone sizes) was 82.2% for children and 40% for the adults. Of the children, 17% had a residual stone compared with 47.8% of the adults. ESWL was unsuccessful in 0.8% of children and 12.2% of adults. The mean number of ESWL sessions required in children and adults was 1.43 (range 1-4) and 2.13 (range 1-4), respectively. Repeat treatment was required in 31% of the children and 65% of the adults. Auxiliary procedures were required in 5.2% of the children and 16.2% of the adults. Complications were seen in 5.6% of the children and 15% of the adults.
CONCLUSION: The results of ESWL for inferior caliceal calculi ≤20 mm in adults remain poor but not so in children. Children can achieve high stone-free rates, require a fewer number of ESWL sessions than adults to be stone free, and have a lower need for repeat treatment and auxiliary procedures, and have fewer complications.
Urology. 2012 Dec;80(6):1209-13. doi: 10.1016/j.urology.2012.08.032. Epub 2012 Oct 4
PMID: 23040726[PubMed - in process]
I agree to the author's conclusion: "ESWL can be considered as the first treatment alternative in the management of lower calyx stones ≤20 mm in children."