EXTRACORPOREAL SHOCKWAVE LITHOTRIPSY IN MANAGEMENT OF UROLITHIASIS IN CHILDREN
Tamer Khodier Abd El-moaty;
Abstract
SUMMARY AND CONCLUSION
E
SWL has revolutionized the treatment of pediatric urinary calculi, contributing to a large extent to the treatment of renal stones.
However; any treatment decision reflects a balance between its benefits of non-invasiveness and effectiveness and its adverse effects that may be significant in pediatric patients.
We performed our study during the period from January 2013 to June 2014. We conducted a prospective study aiming to study the effectiveness and safety of ESWL in treatment of pediatric stones under 12 years old. We enrolled 20 patients in our study. Their age ranged from 4 to 12 years.
In our study, all children below 12 years with radio-opaque renal stones were treated by ESWL as a first line treatment. Age, sex and the side of the stone had no impact on our results.
Patients were then categorized according to stone size and calyceal distribution. All children were treated under general anesthesia. Around 35% of the patients underwent one ESWL session while 65% (Retreatment rate) of the patients required 2 or more sessions to be stone free. Stone free rates and re-treatment rates for stones < 10mm and stones 10-20mm were 100%and 85% respectively.
Stones less than or equal 20mms in size showed very good response to ESWL with excellent fragmentation on follow up radiographs, however , as the stone size increases, stone-free rates decreases, residual fragments increase, the number of sessions and hence the re-treatment rates increase, as well as the number of shock waves and the fluroscopy time per session.
Stone free rates for isolated upper, middle, lower and renal pelvic stones were 100%, 100%, 95 % and 90% respectively. No statistical significant difference was found in the stone free rates among pediatric lower calyceal stones and stones in different renal locations.
Our overall stone free rate was 85%. Complications were encountered in 20% of our patients, transient gross hematuria in 100%, and renal colic in 10%, Stein-strasse in 5% and transient fever in 5% of our patients.
No change in blood urea or creatinine was noted on short term follow up, however, this has to be proved throughout long term follow up of our patients to document the safety of ESWL on kidneys of growing children.
E
SWL has revolutionized the treatment of pediatric urinary calculi, contributing to a large extent to the treatment of renal stones.
However; any treatment decision reflects a balance between its benefits of non-invasiveness and effectiveness and its adverse effects that may be significant in pediatric patients.
We performed our study during the period from January 2013 to June 2014. We conducted a prospective study aiming to study the effectiveness and safety of ESWL in treatment of pediatric stones under 12 years old. We enrolled 20 patients in our study. Their age ranged from 4 to 12 years.
In our study, all children below 12 years with radio-opaque renal stones were treated by ESWL as a first line treatment. Age, sex and the side of the stone had no impact on our results.
Patients were then categorized according to stone size and calyceal distribution. All children were treated under general anesthesia. Around 35% of the patients underwent one ESWL session while 65% (Retreatment rate) of the patients required 2 or more sessions to be stone free. Stone free rates and re-treatment rates for stones < 10mm and stones 10-20mm were 100%and 85% respectively.
Stones less than or equal 20mms in size showed very good response to ESWL with excellent fragmentation on follow up radiographs, however , as the stone size increases, stone-free rates decreases, residual fragments increase, the number of sessions and hence the re-treatment rates increase, as well as the number of shock waves and the fluroscopy time per session.
Stone free rates for isolated upper, middle, lower and renal pelvic stones were 100%, 100%, 95 % and 90% respectively. No statistical significant difference was found in the stone free rates among pediatric lower calyceal stones and stones in different renal locations.
Our overall stone free rate was 85%. Complications were encountered in 20% of our patients, transient gross hematuria in 100%, and renal colic in 10%, Stein-strasse in 5% and transient fever in 5% of our patients.
No change in blood urea or creatinine was noted on short term follow up, however, this has to be proved throughout long term follow up of our patients to document the safety of ESWL on kidneys of growing children.
Other data
| Title | EXTRACORPOREAL SHOCKWAVE LITHOTRIPSY IN MANAGEMENT OF UROLITHIASIS IN CHILDREN | Other Titles | تفتيـت الحصوات بالموجات التصادميه فـــى الأطفــــال | Authors | Tamer Khodier Abd El-moaty | Issue Date | 2014 |
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