Pediatric Low Energy Lithotripsy With the Lithostar

Myers, Dan A.; Mobley, Thomas; Jenkins, Joseph McK.; Grine, William B.; Jordan, William R.

doi:10.1097/00005392-199502000-00055

Cited by 77 publications

(41 citation statements)

References 24 publications

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“…In general, both methods are safe and effective. Despite the minimally invasive nature of in situ ESWL, stone-free success rates vary and multiple treatments are required to achieve a stone-free outcome [24,25]. Furthermore, in situ ESWL is known to be less effective for stones of > 10 mm, impacted stones, radiolucent stones, and for cystine and calcium oxalate monohydrate stones [26][27][28][29].…”

Section: Fig 1 Ab Ivu From a 9-year-old Child With Bilateral Lowementioning

confidence: 99%

Ureteric calculi in children: preliminary experience with holmium:YAG laser lithotripsy

et al. 2004

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laser energy delivered at 0.6-1.4 J and 6-10 Hz. All patients were evaluated after 3 months with intravenous urography to confirm stone clearance and to exclude ureteric stricture formation. RESULTSThe overall stone-free rate was 92% (24 children) after 28 ureteroscopic procedures. Stones were completely cleared in 83%, 80% and 100% of the procedures in the upper, mid-and lower ureters, respectively. In two children the procedure failed; they were salvaged by ureterolithotomy in one and extracorporeal shockwave lithotripsy in the other. During the procedures, a ureteric perforation was caused by several factors, including a technically difficult procedure and higher laser energy. At the mean (range) follow-up of 18 (3-39) months, low grade vesico-ureteric reflux was detected in two children, and there were no ureteric strictures in any. CONCLUSIONHolmium:YAG laser lithotripsy is an efficient and safe treatment for ureteric calculi in children.

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Section: Fig 1 Ab Ivu From a 9-year-old Child With Bilateral Lowementioning

confidence: 99%

Ureteric calculi in children: preliminary experience with holmium:YAG laser lithotripsy

et al. 2004

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“…Estudos têm demonstrado que a litotripsia extracorpórea causa lesões no parênquima renal, relacionadas ao número de impulsos e à intensidade das ondas de choque 10 . Lesões permanentes no parênquima renal, entretanto, não têm sido demonstradas 10 .…”

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Extracorporeal lithotripsy for the treatment of urolithiasis in children

Duarte¹,

Mitre²,

Dénes³

et al. 2002

J Pediatr (Rio J)

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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.

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“…SWL has been the treatment of choice for renal calculi less than 15 mm in size. The stone-free rates range from 68 to 84% [1]. In our study, ESWL was found to be safe and eVective in children as was in adults for solitary renal and upper ureteric stones less than 2 cm in size.…”

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confidence: 51%

Treatment of pediatric urolithiasis: how small is “small enough”?

Desai¹

2011

World J Urol

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"Big" scars for stone removal are only needed in unusual circumstances. This is true given the fact that technology is fast evolving and instruments becoming smaller and smaller. The management of urolithiasis in children has undergone a paradigm shift in the past decade. Management of pediatric urolithiasis necessitates a balance between stone clearance and morbidity related to the procedure. A variety of treatment options are available, which include shock wave lithotripsy (SWL), percutaneous Nephrolithotomy (PCNL), and retrograde intra renal surgery (RIRS) and open surgery. Concerns regarding endourologic treatment include eVect on the renal development and function, the side eVects of radiation, and the implications of residual stones. Children with pediatric urolithiasis need to be worked up metabolically to prevent recurrence.The treatment options should be chosen with prudence, as each of the treatment options has its share of problems. SWL has been the treatment of choice for renal calculi less than 15 mm in size. The stone-free rates range from 68 to 84% [1]. In our study, ESWL was found to be safe and eVective in children as was in adults for solitary renal and upper ureteric stones less than 2 cm in size. We found that children required fewer and lower energy shock waves to achieve equivalent results. Considering that long-term data are awaited regarding functional consequences of shock waves on pediatric kidneys, it would be prudent to shock these kidneys as little as possible. In this context, we feel to minimize the "shock loss," and optimizing the number and energy of shock waves, the patient should be given optimum anaesthesia with the use of ultrasound and Xuoroscopy for localizing and monitoring of stone fragmentation [2].PCNL remains the most eVective option for treating large stones in this age group. The obvious downside of this approach is the potential for life-threatening complications such as bleeding; hence, surgeon experience is paramount in deciding the number and site of access. Stone-free rates of more than 90% have been shown in pediatric age group [3]. Percutaneous Nephrolithotomy has been described even in children as small as 11 months, having complex calyceal stones and/or staghorn calculi. The method to gain access, ultrasound or Xuoroscopy, is a matter of experience and personal preference. Ultrasound oVers the advantage of visualization of spleen and liver and avoids injury. It also minimizes radiation to these kids. The key to success in PCNL in these small patients is staging the procedure if required, miniaturization of instruments, and using ultrasound as the method of achieving access. PCNL oVers a good clearance rates with acceptable morbidity. Miniaturization of instruments particularly smaller nephroscopes and newer energy sources will decrease the morbidity of PCNL. The question is how small is small enough! In this regard, in our opinion, microperc is the "new kid on the block." It has a role to play in percutaneous management of these small patients. Essentially, ...

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Pediatric Low Energy Lithotripsy With the Lithostar

Cited by 77 publications

References 24 publications

Ureteric calculi in children: preliminary experience with holmium:YAG laser lithotripsy

Ureteric calculi in children: preliminary experience with holmium:YAG laser lithotripsy

Extracorporeal lithotripsy for the treatment of urolithiasis in children

Treatment of pediatric urolithiasis: how small is “small enough”?

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