Extracorporeal shock wave lithotripsy (ESWL) was performed for the treatment of urinary tract calculi in 28 children. All treatments were done with the standard Siemens Lithostar device in situ: no special adaptations for adequate positioning of children are required to target the stone precisely. A total of 42 calculi in 30 renal units was treated, requiring 50 ESWL sessions. The mean energy used was 16.4 kv. and the number of shock waves averaged 3,188. Mean fluoroscopy time per session was 1.5 minutes. In 26 of 50 sessions (52%) general anesthesia was needed for the child to remain perfectly still. A complete stone-free rate was achieved in 38 of 42 calculi (90.5%): after 1 session in 30 (71.4%), after 2 sessions in 6 (13.7%) and after 3 sessions in 2 (4.8%). Five staghorn calculi were treated with ESWL monotherapy. A complete stone-free result was obtained after 3 treatments in 2 patients, while 2 had residual fragments in the lower pole (5 mm. after 6 sessions and 11 months of followup in 1, and 7 mm. after 3 sessions and 3 months of followup in 1). A cystine staghorn stone necessitated open nephrolithotomy after 3 sessions without any fragmentation. One impacted sacroiliac ureteral stone required endoscopic laser lithotripsy. Except for these 2 failures no adjuvant procedures were needed. There were no intraoperative or postoperative complications and minor skin bruising at the coupling site after 3 treatments did not require any therapy. We conclude that electromagnetic ESWL with the standard Lithostar unit is a safe and effective method to treat calculi throughout the urinary tract in children.

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The classical treatment of uretero-ileal anastomotic strictures after Bricker uretero-ileostomy is open surgical revision. Recent progress in endourology has provided a number of alternatives. The success rate of these endoscopic techniques is less than the success rate of the open surgical revision.

The results of the self-expandable urethral stent (Wallstent) in the treatment of urethral strictures were evaluated in 7 patients with a followup of 23 to 31 months. The 4 failures were caused by exuberant fibrotic proliferation in the lumen of the stent, which required further endoscopic treatment in 2 patients and even surgical removal of the stent in 1. In the other 2 patients the fibrotic proliferation was progressive and will require further treatment. In 1 patient there is slowly progressive proliferation and a diminishing urine flow rate, and in 2 the fibrotic proliferation seems to be stable. Early reports on the stent suggest that its use will obviate the necessity for complex surgery of urethral stricture. Strictures involving layers deeper than the urothelium and traumatic strictures are not good indications for the self-expandable stent. As this technology continues to evolve, we must continue to follow these patients closely and be attentive to the possible long-term consequences.