Summary and Conclusion
Pediatric stone disease has its own unique features, which are different in both presentation and treatment compared to stone disease in adults. Most pediatric stones are located in the upper urinary tract
ESWL 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.Many reports confirm that shock wave lithotripsy (SWL) can be performed in children with no suspicion of long-term morbidity of the kidney.
The purpose of our work was to evaluate stone clearance in children post extra corporeal shock wave lithotripsy after 3 months.
From September 2014 to September 2015 , 50 children below 18 years with radio-opaque renal stones were treated by Dornier Med Tech lithotripter. Patients were categorized according to stone size and caliceal distribution. All children were treated under general anesthesia with close monitoring of vital signs.
Around 70% of the patients underwent one ESWL session while 30% (Retreatment rate) of the patients required 2 or more sessions to be stone free. Stone free rates and re-treatment rates for stones < 10mm, stones 10-20mm were 95% and 86.6% respectively. 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.
Summery and Conclusion
89
We can also report that obstruction due to stein-strasse was not an infrequent complication (4%) in patients undergoing ESWL. Stone sizes was the most important factor predisposing to the development of stein-strasse.
Stone free rates for upper caliceal, middle caliceal, lower caliceal and renal pelvic stones were 93.5 %, 83.5 %, 80 % and 91 %respectively.
No statistical significant difference was found in the stone free rates among pediatric lower caliceal stones and stones in different renal locations. Our overall stone free rate was 90%. 12 % of the patients had clinically insignificant fragments and were instructed to follow up for the possibility of stone re-growth and the development of microscopic hematuria and urinary tract infection.
Complications were encountered in 12% of our patients, transient gross hematuria in 100%, renal colic in 18 %, Stein-strasse in 4% and transient fever in 6 % of our patients.
No change in serum 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.
Finally, the following conclusions could be drawn fromour study:
ESWL is recommended as the primary treatment of choice for pediatric renal stones < 20mms in all caliceal locations.
ESWL stenting and long term follow up of kidney functions should be analyzed in additional studies. A comparative study between ESWL and PCNL for larger stones as regards stone free rates, re-treatment rates and complications should be addressed in further studies |
