Extracorporeal shock wave lithotripsy in children using the MODULITH
Extracorporeal shock wave lithotripsy (SWL) was introduced for paediatric use as long ago as 1986.
As a treatment option in children with urinary calculus (urolithiasis), this non-invasive technique is known to involve comparatively few side effects.
A study has demonstrated the effectiveness of SWL in children with ureteral calculus, reporting stone-free rates (SFRs) of over 88%¹. On the strength of its non-invasive nature, its successful treatment outcomes and the minimal costs involved, SWL is considered the treatment of choice in children with ureteral calculi of up to 20 mm in diameter².
Urological examinations and therapeutic procedures in children necessitate a particularly careful approach. Firstly, positioning must take into account the considerably smaller size of these patients; secondly, techniques should be favoured that are only mildly, if at all, invasive (in comparison with conventional therapies: URS and PCNL), and that involve energy inputs which are accurately dosed (i.e. precisely adjustable). Exposure to X-rays should be reduced as much as possible, or avoided altogether.
With its MODULITH® SLX-F2 and MODULITH® SLK »inline« systems, STORZ MEDICAL meets all these requirements for non-invasive treatment of calculus in children. The specially designed treatment table – with closed patient positioning sheet – makes safe and comfortable positioning possible, even for small children. A radiation-free ultrasound localization function enables ongoing monitoring of both localization and treatment during SWL. The therapy head can be coupled to the skin using either water or ultrasound gel. Moreover, the electromagnetic principle applied in the STORZ MEDICAL shock wave source ensures that energy release is constant and even. And users can adjust the parameters at low energy levels (1.12 mJ/mm²) so they are just right for smaller patients. Additionally, due to the special cylindrical coil used, in-line ultrasound localization is possible, which means that the shock waves take the same pathway as the ultrasound waves used for localization. This provides a controlled release of shock wave energy into the region being treated.
If X-rays are required, however, two STORZ MEDICAL systems are available – the MODULITH® SLX-F2 »connect« and MODULITH® SLX-F2 »FD21« – that come with a removable anti-scatter grid and an optimized paediatric treatment programme. The child’s exposure to X-rays can be reduced by up to 50%. Furthermore, as of 2020, the MODULITH® SLX-F2 is the first lithotripter in the USA approved for use in the treatment of children aged three and over.
Find more information about extracorporeal shock wave therapy (SWL).
² EAU Guidelines 2020a