Extracorporeal lithotripsy for the treatment of urolithiasis in children

Abstract

Artigo submetido em 21.12.01, aceito em 26.06.02. ResumoObjetivo: cálculos urinários atingem de 5 a 10% da população em alguma fase da vida. Destes casos, somente 2 a 3% são crianças. O tratamento da litíase urinária na faixa pediátrica, com o uso de métodos minimamente invasivos, representa uma alternativa cada vez mais atraente. O presente trabalho objetiva apresentar resultados de litotripsia extracorpórea como tratamento minimamente invasivo de litíase urinária na infância. Métodos AbstractObjective: urinary lithiasis affects between five and 10% of the human population during their lifetime, only 2-3% of whom are children. Therapy of urinary lithiasis in the pediatric age group with minimally invasive methodology represents an attractive alternative. This study presents results of extracorporeal shockwave lithotripsy, a minimally invasive methodology, for the treatment of urinary lithiasis in children.Methods: in the period between September 1991 and September 2000, 87 children were submitted to extracorporeal shockwave lithotripsy; as six of them presented with two calculi 93 urinary calculi were treated over that period. The Dornier-Philips lithotriptor was used in the procedures.Results: Pelvic, superior and medium caliceal calculi were fragmented and eliminated in 87.7% and 77.8% of cases, respectively. Inferior caliceal stones were eliminated in 64.7% of cases. Only one of the three patients with staghorn calculi became stone-free after therapy (33.3%). All patients with ureteral calculi were stone-free after therapy. Bladder stones were fragmented and eliminated in 60% of cases.

Extracorporeal shock wave lithotripsy in children: Results and short‐term complications

“…Contrary to findings reported in other studies, 14,21 we did not observe a lesser efficacy in the treatment of calculi located in the inferior calyx, even though we did not use any different approach to manage this situation.…”

“…Among the 195 treated calculi, the 75.8% fragmentation rate of calculi (64.1% stone‐free and 11.7% ≤ 4 mm residual fragments) is similar to those reported in medical reports 1,12–14 . The success rate was higher for calculi with a diameter smaller than 10.0 mm, a fact also observed in other medical reports 14,15 …”

Urolithiasis in Children with Acute Lymphoblastic Leukemia

“…The frequency of symptomatic UTL found in this study was 3.4% in the pediatric hematology/oncology department, showing a higher occurrence in children with ALL compared with data on general admissions (non published data). Considering that in the general population, 15% of people are affected by stones and that 2 to 3% of cases are represented by children (about 0.3%) [9,[16][17][18], we can say that the rate of 3.4% for lithiasis in children with ALL is higher than that in the general pediatric population. Moreover, this frequency was almost four times higher than the incidence of 0.9% found in a similar study conducted in the United States [14].…”

“…Only two patients needed interventional approach, and, in all cases, extracorporeal shockwave lithotripsy (ESWL) was successful. Generally, the indication for ESWL in children is for stones measuring 5 mm or more [18], and 6 patients fulfilled this criterion. However, the risk-benefit was taken into account, and ESWL was not considered due severe leukopenia and thrombocytopenia.…”

“…Urinary lithiasis is presented by 15% of the general population, and 2 to 3% are represented by children [16][17][18], i.e., an incidence of approximately 0.3 to 0.45%. In the United States an incidence of 1 in 1,000 to 1 in 7,600 pediatric hospital admissions has been reported [19][20][21][22].…”