Comparison between Second and Third Generation Piezoelectric Lithotripsy in Children & Adolescents

Ahn, Seung Hyeun; Bang, Jang Ho; Kai, Won Jun; Moon, Young Tae

Abstract

During a 9-year period 43 children and adolescents 2 to 18 years old underwent 140 extracorporeal shock wave lithotripsy (ESWL) treatments for 48 calculi. The second generation piezoelectric lithotriptor (LT01) was used in 28 cases (65%) while the remaining cases were treated with the third generation piezoelectric lithotriptor (LT02). LT02 lithotriptor differs from an earlier model LT01 in 2 important respects; a stone localization system consisting of ultrasound and fluoroscopy, and more energy per shock wave. The LT01 necessitated caudal anesthesia in 14 cases (50%) while the LT02 necessitated caudal anesthesia in 2 cases (13%) and intravenous anesthesia in 2 cases (13%). Two upper ureteral stones without ureteral dilatation and 1 mid ureteral stone, which were difficult to detect with ultrasound, could be localized by combined ultrasound and fluoroscopy on LT02. The success rate by LT01 and LT02 ESWL was 92.9% and 100%, respectively. The mean session of LT01 and LT02 ESWL was 3.6+/-.4.09 and 2.6+/-2.47, respectively, and the total storage of LT02 ESWL (93+/-97.8) was much less(p<0.05) than that of LT01 ESWL (363+/-380.3). There were no statistical differences in regard to success and the use of stents, stone size or location between the 2 lithotriptors. Six patients required adjuvant procedures, and ESWL complications were not required admission or surgical management. Therefore, LT02 piezoelectric lithotripsy, in comparison with LT01, is more efficient to localize stones and can lessen total storage by reducing treatment sessions in children and adolescents.