Electromagnetic Extracorporeal Shock Wave Lithotripsy in Children

Abstract

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.

Urolithiasis in the Pediatric Age Group

“…9,19,20 In our series, 20 (57.2%) children were treated with ESWL, with an overall clearance rate of 95% and no morbidity.…”

Extracorporeal Shock Wave Lithotripsy in Children

“…ESWL was thus highly effective in the treatment of ureterorenal stone disease in this group of children, and our results compare favorably with those of others. 5,6 The ease with which stone fragments pass through the small ureters of children has been ascribed to several factors. Children are more mobile than adults, and mobility is known to favor stone passage.…”

Childhood Urolithiasis: Urological Management of Upper Tract Calculi in the Era of Extracorporeal Shock-Wave Lithotripsy

“…This particular effectiveness may well be due to the friability of newly formed stones as well as the compliance of the urinary tract which facilitates the elimination of stone fragments [1][2][3].…”

“…The first generation of electrohydraulic extracorporeal lithotriptors (Dornier HM3) requires specific equipment for positioning young children and protecting their lungs from the shock waves [ 1,[4][5][6][7], The majority of later extra corporeal lithotriptors enables children to be treated with out difficulty in positioning or particular protection in relation to their size [3,[8][9][10][11][12].…”

“…The technological improvements and, in particular, the combination of two methods of localizing stones tend to limit the radiation dose as well as endoscopic manipulation prior to ESWL [3,5,6,8,12].…”