Stepwise Shock Wave Lithotripsy: Results Of Initial Study For The Treatment Of Urinary Stones In Childhood

January 5, 2007 – 8:10 pm | posted in Pediatrics, Urology / Nephrology

UroToday.com- A study by Demirci, et al assessed the effectiveness of Stepwise extracorporeal shockwave lithotripsy in the treatment of upper urinary stones in the pediatric population. Between August 1998 and August 2003, a total of 31 patients were treated for renal or ureteral stones. All treatments were performed with a Dornier Compact Delta lithotripter. The number of shock waves was limited to a maximum of 3000 shock waves per session. The voltage was increased in a stepwise fashion beginning at 10 kV and increased to 12.75 kV. Stone clearance rates were assessed at 3 months. The stone free status was defined as the absence of stone fragments.

The group found that a total of 31 stones (24 renal and 7 ureteral stones) were treated. The median age of the patients was 8 years with a range of 9 months to 12 years. The average stone burden was 1 cm for renal stones and 5 mm for ureteral stones. One patient required an open pyelolithotomy for residual stone burden. The overall stone free rates for renal and ureteral stones were 79% and 100%, respectively. They noted that gross hematuria was observed in all cases but was not clinically significant.

They concluded that stepwise shockwave lithotripsy was an effective procedure for the treatment of urinary calculi in the pediatric population. I agree that shockwave lithotripsy is an effective management for stones in children, however, I strongly feel that long term follow-up is necessary in this population to assure that there is no long term risk to the patient.

Demirci, Deniz; Altıok, Erçin; Gülmez, İbrahim; Ekmekçioğlu, Oğuz; Poyrazoğlu, Hakan
International Urology and Nephrology 38(2): 189-192, June 2006.

Reviewed by UroToday.com Medical Editor Pasquale Casale, MD

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