Turna B et al, 2015: Extracorporeal shock wave lithotripsy in infants less than 12-month old.
Turna B, Tekin A, Yağmur İ, Nazlı O.
Department of Urology, Ege University School of Medicine, Bornova, 35100, İzmir, Turkey.
There is a lack of literature on children compared to adults regarding the long-term effects of extracorporeal shock wave lithotripsy (SWL), specifically in infants. The aim of the present study was to analyze the efficacy and safety of SWL in infants and also evaluate its potential adverse effects in the mid-term. Between May 1999 and December 2013, 36 infants with 39 renal units underwent SWL treatment for kidney stones with an electrohydraulic lithotripter (Dornier MPL 9000/ELMED Multimed Classic). All children were less than 12-month old. The mid-term effects of SWL were examined at the last follow-up by measuring arterial blood pressure, random blood glucose level and ipsilateral kidney size. Evaluation of treatment and its consequences was based on clinical examination, blood tests and conventional imaging (plain abdominal radiography and ultrasound). Overall stone-free rate was 84.6 % after 3-month follow-up without any major complications. Mid-term follow-up was available in 20 of 36 children with a mean follow-up of 3.2 ± 2.8 years (range 0.5-15.3). None of the infants were found to develop new onset of hypertension or diabetes. All treated infant kidneys' sizes were in the normal percentile range. SWL for management of infant kidney stones is effective and safe in the mid-term.
Urolithiasis. 2015 Dec 30. [Epub ahead of print]
The authors present results from an unusually large group of ney. The interesting feature of the article is that these children also were followed during longer periods than we usually see.
It is of note that the 3 months’ stone-free rate was 85 % and that as many as 80% of the children were sufficiently treated with only one SWL session. It is also my own experience that the need for repeated SWL in children is low.
During the mean follow-up period of 3.2 years there were no signs of hypertension, diabetes or negative development of the kidney size. However, only one child had a follow-up period longer than 8 years and it is possible that this mid-term follow-up may be too short for definite conclusions on the lack of side effects. Nevertheless, the results so far are convincing that SWL is an excellent treatment modality for very young children, who also seem to clear the fragments in a very efficient way.
Another interesting aspect in the article was the metabolic findings. Hypocitraturia was recorded in 58% of the infants, followed by hypercalciuria in 47%, hyperoxaluria in 26% and hyperuricosuria in 11%. It is in young children that various errors of metabolism as a reason for stone formation can be detected!