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Brad AB. et al., 2019: Particularities and Efficacy of Extracorporeal Shock Wave Lithotripsy in Children

Brad AB., Ferro M., Vartolomei MD., Tătaru S., Anton-Păduraru DT., Simion C., Martha O., Pricop C., Porreca A., Negru I..
Clinic of Urology, Mureş County Clinical Hospital, Târgu Mureș, Romania.
University of Medicine, Pharmacy, Sciences and Technology, Târgu Mureș, Romania.
University of Medicine, Pharmacy, Sciences and Technology, Târgu Mureș, Romania.
Division of Urology, European Institute of Oncology, Milan, Italy.
"Gr.T.Popa" University of Medicine and Pharmacy, Iaşi, Romania.
3rd Clinic of Pediatrics, "Sf.Maria" Children's Emergency Hospital, Iaşi, Romania.
Clinic of Urology, "Dr.C.I.Parhon" Clinical Hospital, Iaşi, Romania.
Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme, Italy.

Abstract

BACKGROUND: Extracorporeal shock wave lithotripsy (ESWL) was first introduced in paediatric population in 1986. Given the more frequent recurrence in children, compared to adults, urinary stones treatments should require minimal invasive treatment methods. In this study, we aimed to evaluate the profile of the young patient with lithiasis who can benefit from ESWL, analysing the experience of 2 clinical departments. MATERIALS AND METHODS: We have retrospectively reviewed the medical records of 54 children who underwent ESWL for urolithiasis. ESWL success rate was defined as stone-free status or the presence of clinically insignificant residual fragments. Data were analysed using the STATA 14.2. RESULTS: In our study, the incidence of renal-ureteral calculi is significantly higher in girls (68.5%), compared to boys (31.5%). In total, 83.3% of patients showed a favourable outcome after treatment and the remaining 16.7% showed minimal complications. The presence of complications and remaining calculi was correlated to children age. The overall stone free rate was 88.9%. For calculus of 8.5 mm, only one ESWL session is recommended. CONCLUSIONS: The high percentage of cases with favourable outcome indicate that ESWL treatment is effective, considering the minimal cost, minimal invasiveness, repeatability and no need for general anaesthesia.

Urol Int. 2019;103(3):318-325. doi: 10.1159/000502101. Epub 2019 Aug 6.

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Comments 1

Hans-Göran Tiselius on Friday, December 13 2019 08:15

SWL is an excellent treatment for children with stones and this method also commonly is recommended in guidelines. The surprising finding in this population of 54 children was that almost 69% were girls.

Although it is stated that the children were treated with 1800-4000 shock waves at a frequency of 1.5 Hz it is not mentioned which lithotripter that was used. None of the children were treated with general anaesthesia but it needs to be observed that 83% of the children were teenagers.

One session was sufficient in 83% and the reported stone-free rate was 89%.

The conclusion made was that for stones 12 mm repeated treatments were necessary. Although the authors define success as stone-free or stone-free + clinically insignificant fragments, it is unclear if the reported stone-free rate is the same as successful treatment.

The bottom-line of this report was that SWL:

1. is a minimally invasive treatment
2. can be repeated
3. does not require anaesthesia
4. rarely is associated with complications
5. is successful in 89% of treated children

SWL is an excellent treatment for children with stones and this method also commonly is recommended in guidelines. The surprising finding in this population of 54 children was that almost 69% were girls. Although it is stated that the children were treated with 1800-4000 shock waves at a frequency of 1.5 Hz it is not mentioned which lithotripter that was used. None of the children were treated with general anaesthesia but it needs to be observed that 83% of the children were teenagers. One session was sufficient in 83% and the reported stone-free rate was 89%. The conclusion made was that for stones 12 mm repeated treatments were necessary. Although the authors define success as stone-free or stone-free + clinically insignificant fragments, it is unclear if the reported stone-free rate is the same as successful treatment. The bottom-line of this report was that SWL: 1. is a minimally invasive treatment 2. can be repeated 3. does not require anaesthesia 4. rarely is associated with complications 5. is successful in 89% of treated children
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