Extracorporeal shockwave lithotripsy in children
Friday, 7 November 2008 - Extracorporeal shockwave lithotripsy (ESWL) represents a well-established and effective treatment of urinary stones in adult patients. Ignorance about indication varieties and side effect on ESWL in paediatric patients still causes unnecessary stone surgery.
Lead author Dr. Rucsandra Manu and colleagues conducted a study that was designed to assess the technique, complications and long term results of ESWL in paediatric patients. Manu presented the study, which won the second prize Karl Storz award for best abstract, at the recently held EAU 8th Central European Meeting in Warsaw, Poland.
Between 1991 and 2008, 259 children (the youngest 3,3 years, the oldest 16 year mean age 11,4 years old) were treated by ESWL for urinary stones at the author’s institution (using Dornier Compact Lithotripter and Siemens Lithostar Multiline). In 146 cases the calculus was located in the renal pelvis, in 49 cases a single calculus was located in the calyx, 24 cases had pyelo-caliceal lithiasis, in 23 cases the calculus advanced in the lumbar ureter and two children had staghorn lithiasis. Stone size was in 27% < 10mm, in 53% 11-20 mm, 16% 21-30mm and in 4% larger than 30 mm. General intravenous anaesthesia has been used in 229 cases and no sedation was used in 30 cases.
The results showed that the overall "stone free" rate was 91%. Minor early complications were seen in 28 patients. In 15 cases the ureter was blocked by "steinstrasse" and fortunately the fragments were spontaneously eliminated. In 3 cases the ESWL was inefficient and
the patients underwent surgery. No late complications (renal failure, skeletal deformation) were noticed during a mean follow-up period of 36 months.
The authors concluded that ESWL is effective in paediatric patients (“stone-free” rate = 91%) and added that ESWL can be safely performed without long term side effects on the function and morphology of the growing kidney.
Source: Sinescu I.C., Manu R., Manu M.A., et al., Fundeni Clinical Institute, Centre of Urological Surgery, Dialysis and Renal Transplantation, Bucharest, Romania, Abstract 120, Second Prize, Karl Storz Award, "Extracorporeal shockwave lithotripsy in children – another confirmation of its efficiency," EAU 8th Central European Meeting, 24-25 October 2008, Warsaw, Poland.