Korean J Urol.  2013 Jul;54(7):460-466.

Factors Affecting the Outcome of Extracorporeal Shock Wave Lithotripsy for Unilateral Urinary Stones in Children: A 17-Year Single-Institute Experience

• Jeong US
• Lee S
• Kang J
• Han DH
• Park KH
• Baek M

Abstract

PURPOSE
Extracorporeal shock wave lithotripsy (ESWL) is a first-line treatment for pediatric urinary stone disease. We aimed to determine the factors affecting the outcome of ESWL for unilateral urinary stones in children.
MATERIALS AND METHODS
A total of 81 pediatric patients aged 0 to 16 years with urinary stones treated by ESWL from January 1995 through May 2012 were retrospectively reviewed. All patients were required to have unilateral urinary stone disease. Children who underwent other surgical procedures before ESWL were excluded. Outcomes evaluated after ESWL were the stone-free rate at 3 months after ESWL, success within a single session, and success within three sessions. Factors affecting the success within three sessions were also analyzed.
RESULTS
The final analysis was for 42 boys and 22 girls (mean age, 9.2+/-5.2 years). Of these 64 patients, 58 (90.6%) were treated by ESWL without other surgical procedures and 54 (84.4%) were successfully treated within three ESWL sessions. In the multivariate analysis, multiplicity (odds ratio [OR], 0.080; 95% confidence interval [CI], 0.012 to 0.534; p=0.009) and large stone size (>10 mm; OR, 0.112; 95% CI, 0.018 to 0.707; p=0.020) were significant factors that decreased the success rate within three ESWL sessions.
CONCLUSIONS
Most of the pediatric urinary stone patients in our study (90.6%) were successfully treated by ESWL alone without additional procedures. If a child has a large urinary stone (>10 mm) or multiplicity, clinicians should consider that several ESWL sessions might be needed for successful stone fragmentation.

Keyword

Lithotripsy; Pediatrics; Treatment outcome; Urinary calculi

MeSH Terms

Aged
Child
Humans
Lithotripsy
Multivariate Analysis
Pediatrics
Retrospective Studies
Shock
Treatment Outcome
Urinary Calculi

Reference

1. Mandeville JA, Nelson CP. Pediatric urolithiasis. Curr Opin Urol. 2009. 19:419–423.

2. Smaldone MC, Corcoran AT, Docimo SG, Ost MC. Endourological management of pediatric stone disease: present status. J Urol. 2009. 181:17–28.

3. Newman DM, Coury T, Lingeman JE, Mertz JH, Mosbaugh PG, Steele RE, et al. Extracorporeal shock wave lithotripsy experience in children. J Urol. 1986. 136(1 Pt 2):238–240.

4. Lee HS, Jung JI, Choi HS, Shin SJ, Choi SH. Extracorporeal shock wave lithotripsy in 17 children. Korean J Urol. 1994. 35:277–282.

5. Ahn SH, Bang JH, Kai WJ, Moon YT. Comparison between second and third generation piezoelectric lithotripsy in children & adolescents. Korean J Urol. 1997. 38:600–604.

6. Cho SW, Seo IY, Rim JS. Extracorporeal shock wave lithotripsy for 57 cases of pediatric urinary stone with EDAP LT-01+ and Storz Modulith SLX lithotriptors. Korean J Urol. 2002. 43:743–747.

7. Rodrigues Netto N Jr, Longo JA, Ikonomidis JA, Rodrigues Netto M. Extracorporeal shock wave lithotripsy in children. J Urol. 2002. 167:2164–2166.

8. Ather MH, Noor MA. Does size and site matter for renal stones up to 30-mm in size in children treated by extracorporeal lithotripsy? Urology. 2003. 61:212–215.

9. Muslumanoglu AY, Tefekli A, Sarilar O, Binbay M, Altunrende F, Ozkuvanci U. Extracorporeal shock wave lithotripsy as first line treatment alternative for urinary tract stones in children: a large scale retrospective analysis. J Urol. 2003. 170(6 Pt 1):2405–2408.

10. Aksoy Y, Ozbey I, Atmaca AF, Polat O. Extracorporeal shock wave lithotripsy in children: experience using a mpl-9000 lithotriptor. World J Urol. 2004. 22:115–119.

11. Tan AH, Al-Omar M, Watterson JD, Nott L, Denstedt JD, Razvi H. Results of shockwave lithotripsy for pediatric urolithiasis. J Endourol. 2004. 18:527–530.

12. Defoor W, Dharamsi N, Smith P, Sekhon D, Colombo J, Riden D, et al. Use of mobile extracorporeal shock wave lithotripter: experience in a pediatric institution. Urology. 2005. 65:778–781.

13. Muslumanoglu AY, Tefekli AH, Altunrende F, Karadag MA, Baykal M, Akcay M. Efficacy of extracorporeal shock wave lithotripsy for ureteric stones in children. Int Urol Nephrol. 2006. 38:225–229.

14. Demirkesen O, Onal B, Tansu N, Altintas R, Yalcin V, Oner A. Efficacy of extracorporeal shock wave lithotripsy for isolated lower caliceal stones in children compared with stones in other renal locations. Urology. 2006. 67:170–174.

15. Wadhwa P, Aron M, Seth A, Dogra PN, Hemal AK, Gupta NP. Pediatric shockwave lithotripsy: size matters! J Endourol. 2007. 21:141–144.

16. Raza SJ, Ather MH. Does the type of lithotripter affect outcomes in children with upper tract urolithiasis? J Endourol. 2009. 23:223–227.

17. Aksoy Y, Ziypak T, Yapanoglu T. Comparison of the effectiveness and safety of MPL 9000 and Lithostar Modularis shockwave lithotriptors: treatment results of 263 children. Urol Res. 2009. 37:111–116.

18. Kim KH, Chung SK, Chang HS, Park JS, Kim HT, Moon KH. Long-term safety on extracorporeal shock-wave lithotripsy (SWL) in preschoolers: a multicenter study. Korean J Pediatr Urol. 2010. 2:38–42.

19. He L, Sun X, Lu J, Cong X, Zhu H, Shen L, et al. Comparison of efficacy and safety of shockwave lithotripsy for upper urinary tract stones of different locations in children: a study of 311 cases. World J Urol. 2011. 29:713–717.

20. Badawy AA, Saleem MD, Abolyosr A, Aldahshoury M, Elbadry MS, Abdalla MA, et al. Extracorporeal shock wave lithotripsy as first line treatment for urinary tract stones in children: outcome of 500 cases. Int Urol Nephrol. 2012. 44:661–666.

21. Shukla AR, Hoover DL, Homsy YL, Perlman S, Schurman S, Reisman EM. Urolithiasis in the low birth weight infant: the role and efficacy of extracorporeal shock wave lithotripsy. J Urol. 2001. 165(6 Pt 2):2320–2323.

22. Preminger GM, Tiselius HG, Assimos DG, Alken P, Buck C, Gallucci M, et al. 2007 guideline for the management of ureteral calculi. J Urol. 2007. 178:2418–2434.

23. McAdams S, Shukla AR. Pediatric extracorporeal shock wave lithotripsy: predicting successful outcomes. Indian J Urol. 2010. 26:544–548.

24. Sampaio FJ, Aragao AH. Limitations of extracorporeal shockwave lithotripsy for lower caliceal stones: anatomic insight. J Endourol. 1994. 8:241–247.

25. Sabnis RB, Naik K, Patel SH, Desai MR, Bapat SD. Extracorporeal shock wave lithotripsy for lower calyceal stones: can clearance be predicted? Br J Urol. 1997. 80:853–857.

26. Goktas C, Akca O, Horuz R, Gokhan O, Albayrak S, Sarica K. SWL in lower calyceal calculi: evaluation of the treatment results in children and adults. Urology. 2011. 78:1402–1406.

27. D'Addessi A, Bongiovanni L, Sasso F, Gulino G, Falabella R, Bassi P. Extracorporeal shockwave lithotripsy in pediatrics. J Endourol. 2008. 22:1–12.