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Asi T. et al., 2020: Shockwave lithotripsy for kidney stones as a first-line therapy in children younger than 2 years

Asi T, Dogan HS, Altan M, Bozaci AC, Ceylan T, Asci A, Tekgul S.
Department of Urology, Hacettepe University, Faculty of Medicine, Ankara, Turkey.
Department of Urology, Hacettepe University, Faculty of Medicine, Ankara, Turkey.

Abstract

BACKGROUND: The incidence of urolithiasis in children has risen worldwide over the last decades with geographical varieties. As pediatric patients begin forming stones earlier in life, they have high risk of recurrence. Extracorporeal shockwave lithotripsy (SWL) is a non-invasive treatment modality that is preferred in the management of pediatric stones. Reports about the safety and efficacy of SWL in patients younger than 24 months are scarce in the literature.

OBJECTIVE: The aim of the study was to evaluate the effectiveness and safety of SWL in patients younger than 24 months. The authors also aimed to assess the validity of the Dogan nomogram in predicting stone-free rates.

STUDY DESIGN:
Between January 2009 and March 2019, data of 247 patients younger than 24 months at the time of SWL were retrospectively collected. Analysis was performed on 260 renal units. Success was considered in patients who were completely free of stones after the first session.

RESULTS AND DISCUSSION: The female/male ratio was 103/157, with a median age of 15 (5-24) months, a median stone size of 8 (3-30) mm and a median follow-up period of 7 (3-20) months. Multiple stones and lower calyx stones were observed in 19.6% (51/260) and 23.4% (61/260) of patients, respectively. Complications were detected in 5.8% (15/260) of patients (9 with steinstrasse, 3 with UTI, 2 with vomiting, 1 with hematuria). After the first session, 56.9% (148/260) of patients were stone-free. Forty-six of the failed 112 first sessions underwent second session. A total of 5 patients had a third session. The efficacy quotient was 57%. On univariate analysis, younger age (≤16 months), single stone, small stone size (<10 mm), and non-lower pole location were significant predictors of stone clearance. On multivariate analysis, younger age (=<16 months) and single stone remained significant. The Dogan nomogram score lower than 150 was found to be a good cutoff point to predict better stone clearance (Table).

CONCLUSION: Shockwave lithotripsy is a safe and effective treatment modality in patients younger than 24 months and could be the first option in this particular age-group in whom the other endourological modalities are not always applicable. The Dogan nomogram is reliable in predicting the stone-free rate in this age-group.
J Pediatr Urol. 2020 Jan 10. pii: S1477-5131(20)30002-4. doi: 10.1016/j.jpurol.2020.01.001. [Epub ahead of print].

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Comments 1

Peter Alken on Friday, June 12 2020 08:30

“Of all patients, 56.9% (148/260) were stone-free after the first session. The failed
112 cases were offered a second session. Although 46 of them accepted, the rest asked for another treatment modality. Five of the 46 patients had a third session, making the total SWL procedures to be 311. The overall stone-free rates were 56.9% (148/260), 56.5% (26/46), and 60% (3/5) for the first, the second, and the third session, respectively.” This means that 177 (43%) of the 311 ESWL sessions were in vain under the criteria of no residuals seen with sonography.
The Dogan Nomogram (1) to predict ESWL success in children stems from the same institution. 40% of the present patients previously formed part to design the nomogram.
Unfortunately the present paper does not give easy to catch and exact information about the predictive values in this lager patient group.

1 Dogan HS, Altan M, Citamak B, Bozaci AC, Karabulut E, Tekgul S. A new nomogram for prediction of outcome of pediatric shock-wave lithotripsy. J Pediatr Urol. 2015;11(2):84.e1–84.e846. doi:10.1016/j.jpurol.2015.01.004

“Of all patients, 56.9% (148/260) were stone-free after the first session. The failed 112 cases were offered a second session. Although 46 of them accepted, the rest asked for another treatment modality. Five of the 46 patients had a third session, making the total SWL procedures to be 311. The overall stone-free rates were 56.9% (148/260), 56.5% (26/46), and 60% (3/5) for the first, the second, and the third session, respectively.” This means that 177 (43%) of the 311 ESWL sessions were in vain under the criteria of no residuals seen with sonography. The Dogan Nomogram (1) to predict ESWL success in children stems from the same institution. 40% of the present patients previously formed part to design the nomogram. Unfortunately the present paper does not give easy to catch and exact information about the predictive values in this lager patient group. 1 Dogan HS, Altan M, Citamak B, Bozaci AC, Karabulut E, Tekgul S. A new nomogram for prediction of outcome of pediatric shock-wave lithotripsy. J Pediatr Urol. 2015;11(2):84.e1–84.e846. doi:10.1016/j.jpurol.2015.01.004
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