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Kızılay F. et al., 2020: Factors affecting the success of pediatric extracorporeal shock wave lithotripsy therapy: 26-year experience at a single institution

Kızılay F, Özdemir T, Turna B, Karaca N, Şimşir A, Alper I, Nazlı O.
Departments of Urology, Ege University Faculty of Medicine, İzmir, Turkey.
Departments of Anaesthesiology, Ege University Faculty of Medicine, İzmir, Turkey.

Abstract

Despite its widespread use, few studies have evaluated the success of extracorporeal shock wave lithotripsy (ESWL) in pediatric patients with several parameters and a large group of patients. In the present study, we aimed to analyze the factors that affect the outcomes of pediatric ESWL treatment, which we have practiced for 26 years. This study included 1012 pediatric patients who underwent ESWL between March 1991 and November 2017. Pre-procedure radiological evaluations were performed using kidney-ureter-bladder and/ or urinary system ultrasonography. Demographic data, stone characteristics, and ESWL treatment data and complications were recorded and univariate and multivariate analyses were performed for the stone-free rate (SFR). Receiver operating characteristic (ROC) analysis was performed to determine the cut-off values for stone size to predict ESWL success for both kidney and ureteral stones. Age, body mass index (BMI), congenital renal anomaly, stone location, stone size, number of stones, and stone composition significantly affected the SFRs in univariate analysis; however, only age, BMI, stone location, and stone size were significant in the multivariate analysis. If no residual fragments were detected after three sessions of ESWL application, the procedure was considered successful. The cut-off stone size values for the kidney and ureter that predicted treatment success were 96.28 mm2 and 44.16 mm < sup > 2 < /sup > , respectively. ESWL is an effective and safe treatment in the pediatric age group that provides high SFRs. Age, BMI, and stone location, size, and composition are particularly critical factors that can predict the success of ESWL.
Turk J Pediatr. 2020;62(1):68-79. doi: 10.24953/turkjped.2020.01.010. PMID: 32253869. FREE ARTICLE

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Commentaires 1

Peter Alken le mercredi 4 novembre 2020 08:30

This is a large series with a stone free rate of 78,6%. “After a total of 3 ESWL sessions, children without residual fragments were considered stone-free; otherwise, the procedure was considered unsuccessful. Stone free was accepted as the absence of any fragments in control imaging methods. Fragments less than 4 mm were considered clinically insignificant residual fragments. However, the criteria for success and statistical analysis was stone free status.”

The anesthesia method might be of interest for clinicians:
Anesthesia was induced via a facemask with 8% sevoflurane … until an intravenous cannula was indwelled.
Afterward, intravenous infusion of 0.9% sodium chloride (NaCl) was started and 10 μg/kg atropine, 0.05 mg/kg midazolam, and 0.5-1 mg/kg ketamine as a slow bolus over 60s were administered ...
“Anesthesia was maintained with an additional dose of 0.5 mg/kg ketamine given according to clinical parameters, such as moving or moaning from pain induced by shock waves.”
Patients were discharged the same day.

Peter Alken

This is a large series with a stone free rate of 78,6%. “After a total of 3 ESWL sessions, children without residual fragments were considered stone-free; otherwise, the procedure was considered unsuccessful. Stone free was accepted as the absence of any fragments in control imaging methods. Fragments less than 4 mm were considered clinically insignificant residual fragments. However, the criteria for success and statistical analysis was stone free status.” The anesthesia method might be of interest for clinicians: Anesthesia was induced via a facemask with 8% sevoflurane … until an intravenous cannula was indwelled. Afterward, intravenous infusion of 0.9% sodium chloride (NaCl) was started and 10 μg/kg atropine, 0.05 mg/kg midazolam, and 0.5-1 mg/kg ketamine as a slow bolus over 60s were administered ... “Anesthesia was maintained with an additional dose of 0.5 mg/kg ketamine given according to clinical parameters, such as moving or moaning from pain induced by shock waves.” Patients were discharged the same day. Peter Alken
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jeudi 22 avril 2021

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