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Tuncer M et al, 2017: Extracorporeal Shock Wave Lithotripsy Management of Renal Stones in Children: Does Anesthesia Affect the Treatment Outcomes on an Age Based Manner ?

Tuncer M, Çevik B, Eryıldırım B, Faydacı G, Sarıca K.
Department of Anaesthesia, Dr. Lutfi Kirdar Kartal Training and Research Hospital, Istanbul, Turkey.
Department of Urology, Dr. Lutfi Kirdar Kartal Training and Research Hospital, Istanbul, Turkey.

Abstract

OBJECTIVE: To evaluate beneficial effect of anaesthesia on extracorporeal shock wave lithotripsy (SWL) in children older than nine years.
PATIENTS AND METHODS: A total of 61 children (aging between 9-17 years) treated with SWL for renal stones were included. Depending on the use of general anesthesia, children were divided into two groups; (Group 1, n=27) Cases treated with SWL under anesthesia and (Group 2, n=34) SWL without anesthesia. Patients in both groups were comparatively evaluated with respect to treatment related (stone size, stone laterality, stone location, mean number of sessions, mean number of shock waves applied, residual fragments size, stone free rate (SFR), clinically significant residual fragment complications and need of additional intervention) parameters. Efficacy quotient was also evaluated.
RESULTS: Overall mean stone size was 10,48±4,27 mm. Although there was no significant difference regarding the stone size (p=0,924), stone laterality (p=0,240), stone localization (p=0,084) mean number of sessions (p=0,392), SFR (p=0,666), clinically significant residue (p=0,526) size of residual fragments (p=0,315) complication rates (p=1,000) and need of additional intervention (p=1,000); mean number of shock waves applied was significantly higher in patients treated without anesthesia (Grup-2) (p=0,001). Efficacy quotient was 41,7% and 35,4% for Group 1 and Group 2, respectively.
CONCLUSIONS: Our findings indicate that anesthesia free SWL for renal stones in children aging older than 9 years is feasible and successful with similar treatment outcome data observed in the same age ranged cases being treated under anesthesia. We believe that "SWL without anesthesia" can be applied in a safe and sucessful manner in relatively older and cooperative children.

Urology. 2017 May 22. pii: S0090-4295(17)30513-7. doi: 10.1016/j.urology.2017.05.020. [Epub ahead of print]

 

 

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Comentarios 1

Hans-Göran Tiselius en Miércoles, 20 Septiembre 2017 09:35

It is in no way surprising to me that the need of anaesthesia (Ketamin) most commonly was encountered in the low age group. More surprisingly is it that so many children completed SWL without anaesthesia.

It is slightly difficult to make a correct interpretation of the result, but it is possible that larger residual stone size and lower stone free rates in the anaesthesia-free group, despite the use of larger number of shockwaves, might have been improved by anaesthesia.

The statistics is hampered by the relatively small number of children in each group.

It is in no way surprising to me that the need of anaesthesia (Ketamin) most commonly was encountered in the low age group. More surprisingly is it that so many children completed SWL without anaesthesia. It is slightly difficult to make a correct interpretation of the result, but it is possible that larger residual stone size and lower stone free rates in the anaesthesia-free group, despite the use of larger number of shockwaves, might have been improved by anaesthesia. The statistics is hampered by the relatively small number of children in each group.
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