Extracorporeal shock wave lithotripsy in children: Non-invasive stone treatment with the MODULITH
The number of children affected by kidney and ureteral stones is increasing worldwide. By 2040, the number of new cases is expected to rise by approximately 20% to more than 1.5 million annually.¹
This trend highlights the importance of gentle yet effective treatment options in paediatric care.
Against this background, the search for safe, effective and child-friendly treatment options is becoming increasingly important.
Clinical evidence: High stone-free rates in children with kidney and ureteral stones
Recent studies²˒³˒⁴ have shown that extracorporeal shock wave lithotripsy (SWL) is a safe and effective treatment option for kidney and ureteral stones in children. According to the guidelines of the European Association of Urology (EAU) and the American Urological Association (AUA), SWL is a recommended treatment option for paediatric patients with urinary stones measuring less than 20 mm.
SWL is associated with a low reported pain intensity and limited post-procedural symptoms. In the patient populations studied, children were reported to return quickly to their normal school routine, while parents were able to resume work shortly after treatment. The use of ureteral stents is reported less frequently in connection with SWL.
High stone-free rates (SFRs) have been documented for ultrasound-guided SWL: after a single treatment session, the stone-free rate at 12 weeks was 88.0%, while the overall success rate after completion of all treatment sessions reached 91.7%.³ The studies describe SWL as a procedure that can be performed on an outpatient basis.
Special requirements in the treatment of children with urinary stones
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.
MODULITH systems: Precise and gentle SWL treatment for children
With its MODULITH® SLX-F2 and MODULITH® SLK »inline« systems, STORZ MEDICAL meets all these requirements for non-invasive stone treatment 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. Users can adjust the SWL parameters at low energy levels (1.12 mJ/mm²) so they are precisely adapted to 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.New
Reduced radiation exposure in paediatric stone treatment
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).
References
¹ Hu, J., et al. (2025). Global, Regional, and National Epidemiology of Pediatric Urolithiasis (1990–2021) and 2040 Forecast. The Journal of Urology, 214(4), 435–445. https://doi.org/10.1097/JU.0000000000004645
² Tasian, G. E., et al. (2025). Ureteroscopy vs Shockwave Lithotripsy to Remove Kidney Stones in Children and Adolescents: A Nonrandomized Clinical Trial. JAMA Network Open, 8(8), e2525789. https://doi.org/10.1001/jamanetworkopen.2025.25789
³ Grabsky, A., et al. (2021). Effectiveness of ultrasound-guided shockwave lithotripsy and predictors of its success rate in pediatric population: A report from a national reference center. Journal of Pediatric Urology, 17(1), 78.e1–78.e7. https://doi.org/10.1016/j.jpurol.2020.10.014
⁴ Chatzikrachtis, N., et al. (2023). Complication rate after pediatric shock wave lithotripsy according to Clavien–Dindo grading system: results from a systematic review and meta-analysis of the existing literature. World Journal of Urology, 41(4), 829–835. https://doi.org/10.1007/s00345-022-04267-x
