Extracorporeal shock wave lithotripsy
Springer Online Journal Archives 1860-2000
Abstract Childhood urolithiasis is uncommon, comprising 2% – 3% of urinary calculi. This paper presents our initial experience in the endourological (EU) treatment of 23 children with urinary calculi presenting to the Royal Childrens' Hospital. Twenty-seven renal, ureteric, and vesical calculi were treated. Three strictures were divided endoscopically synchronously with calculus removal. Twenty-three calculi were renal (6 staghorn, 3 cystine), 2 ureteric, and 2 vesical. In 12 patients (mean age 17.5 years, range 5–24), the underlying cause was a neuropathic bladder secondary to spina bifida. Ten of these had ileal conduits, 1 was successfully undiverted, and 1 previously undiagnosed (all infected). The second group of 11 patients (mean age 10.1 years, range 5–16) had normal renal anatomy. Seventeen (63%) were treated by percutaneous nephrolithotomy (PCNL) or endoscopic lithotripsy via their conduit (n = 1) or bladder (n = 2). Three (11%) underwent combined extracorporeal shock wave lithotripsy (ESWL) and PCNL and 7 (26%) were treated by ESWL alone. Twenty-one (77%) were cleared of stone by their primary procedure. Four patients with residual calculi following ESWL have a decreased volume of stone and 2 patients with staghorn calculi treated by PCNL have peripheral fragments only (1 bilateral). There was no mortality or significant morbidity except sepsis in 4 patients, which was treated medically. This series demonstrates that EU and ESWL techniques are safe and effective in children and patients with spina bifida, who often have marked scoliosis, urinary diversion, and difficulties in access. In our experience, paediatric calculi were associated with infection, metabolic disorders, urinary diversion, and patient deformities, and so the majority were more appropriately treated by endourological techniques. ESWL was effective for small stones and in combination with EU for complex stones. By using EU and ESWL alone or in combination, we have avoided open surgery in all patients with urinary calculi treated so far.
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