Is mini-percutaneous nephrolithotomy a safe alternative to extracorporeal shockwave lithotripsy in pediatric age group in borderline stones? a randomized prospective study (original) (raw)
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Erciyes Medical Journal, 2017
Objective: We aimed to investigate the effectiveness of shock wave Lithotripsy (SWL) and factors affecting seance number while treating children with renal stones. Materials and Methods: A total of 50 children (53 renal units) who underwent SWL for renal stones between 2012 and 2014 were investigated retrospectively. The demographics of patients, the number, size, side, location, and radiolucency of stones in kidneys, placement of JJ stents, shock number, energy, seance number, stone-free rate, and complications were noted. Results: Patients involved 25 girls and 25 boys with a median age of 4.0 years ranging from eight months to 16 years (21≤3y). Stones were located in the renal pelvis and calyxes in 20 and 33 patients, respectively. Of the renal stones, 33 were single and 20 were multiple. The mean stone size was 11.02±5.4 mm. Success rates were 45.3, 75.5, and 92.5% after seances 1, 2, and 3, respectively. Per seance, the mean SWL shock waves and energy were 1219±262 and 12.6±0.9 kV. A significant relationship was found between the need for a third seance and patient age (≤3 years and >3), radiolucent and radiopague, ≤10 mm and >10 mm or single and multiple stone (p<0.05). However, no significant relationship was found between success rate and age; sex; number, size, location, and side of stones; and radiolucent stones. Conclusions: Age, radiolucency, stone size, and number of stones were significant predictors of SWL success in children. We observed that stone-free status is achieved more quickly, even within the first or second SWL seances by significantly decreasing the need for the third séance in group age ≤3 years, radiolucent, ≤10 mm or single renal stones.
Urology, 2005
Objectives. To evaluate the efficacy of extracorporeal shock wave lithotripsy (ESWL) monotherapy for isolated lower caliceal calculi in a pediatric age group and compare it with that for isolated middle/upper caliceal and renal pelvic calculi. Methods. We retrospectively reviewed the data of 151 renal units in 126 children treated with ESWL for isolated caliceal and renal pelvic stones from March 1992 to February 2004. The stones were localized in the lower, middle/upper calices, and renal pelvis in 50, 26, and 75 renal units, respectively. The results were compared with respect to renal location and stone burden. Results. The median patient age was 8 years (range 1 to 16). The median stone burden in the lower and middle/upper caliceal groups was significantly lower than in the renal pelvis group at 0.6, 0.6, and 1 cm 2 , respectively (P ϭ 0.002). The overall stone-free rate was 62% for lower calices, 65.3% for middle/ upper calices, and 80% for renal pelvis stones. For the group with a stone size greater than 2 cm 2 , the stone-free rate decreased to 33% in both lower and middle/upper calices; however, it was almost the same in the renal pelvis (81.8%). A highly significant relation was found between the stone burden and number of sessions (P Ͻ0.001), but none between the stone burden and stone-free rate. Conclusions. In our study, ESWL was equally effective for stones in all locations. We recommend ESWL as the primary treatment of choice for stones less than 2.0 cm 2 in all caliceal locations. For the management of caliceal stones greater than 2.0 cm 2 , prospective randomized trials comparing ESWL and percutaneous nephrolithotomy are necessary.
Urology, 2006
Objectives. To evaluate the efficacy of extracorporeal shock wave lithotripsy (ESWL) monotherapy for isolated lower caliceal calculi in a pediatric age group and compare it with that for isolated middle/upper caliceal and renal pelvic calculi. Methods. We retrospectively reviewed the data of 151 renal units in 126 children treated with ESWL for isolated caliceal and renal pelvic stones from March 1992 to February 2004. The stones were localized in the lower, middle/upper calices, and renal pelvis in 50, 26, and 75 renal units, respectively. The results were compared with respect to renal location and stone burden. Results. The median patient age was 8 years (range 1 to 16). The median stone burden in the lower and middle/upper caliceal groups was significantly lower than in the renal pelvis group at 0.6, 0.6, and 1 cm 2 , respectively (P ϭ 0.002). The overall stone-free rate was 62% for lower calices, 65.3% for middle/ upper calices, and 80% for renal pelvis stones. For the group with a stone size greater than 2 cm 2 , the stone-free rate decreased to 33% in both lower and middle/upper calices; however, it was almost the same in the renal pelvis (81.8%). A highly significant relation was found between the stone burden and number of sessions (P Ͻ0.001), but none between the stone burden and stone-free rate. Conclusions. In our study, ESWL was equally effective for stones in all locations. We recommend ESWL as the primary treatment of choice for stones less than 2.0 cm 2 in all caliceal locations. For the management of caliceal stones greater than 2.0 cm 2 , prospective randomized trials comparing ESWL and percutaneous nephrolithotomy are necessary. UROLOGY 67: 170-175, 2006.
Korean Journal of Urology, 2013
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.
Journal of Pediatric Urology, 2013
To determine the effect of location and size of stones on the outcome of extracorporeal shock wave lithotripsy (ESWL) in children. Patients and methods: In 2008e2010, 150 children (median age 6.6 years) with radio-opaque ureteric and renal stones measuring 4 cm were treated. Exclusion criteria were coagulation disorders, pyelonephritis, distal obstruction, non-functioning kidney and hypertension. ESWL was performed under general anesthesia. Follow up period was 5e22 months. Results: 186 stones were treated: 76 calyceal, 92 pelvic and 18 proximal ureteral. Mean stone size was 1.3 cm. A total of 312 sessions were performed (mean per stone Z 1.67 sessions). The mean number of shock waves per session was 2423.68. Overall stone-free rate was 89.24%. Having a calyceal location did not significantly affect the stone-free rate (p Z 0.133). The failure rate was significantly higher (66.7%) in stones >3 cm in size (p < 0.001). Complications were encountered in 18 patients; 2 underwent auxillary ureteroscopy and 4 uretrolithotomy for treatment of steinstrasse. Conclusion: ESWL is a safe and effective method for treatment of stones up to 2 cm in children. Rate of auxillary procedures increases in stones >2 cm in size. About 80% of failures were associated with stone size >1.35 cm while 52.3% of completely cleared stones were associated with size <1.35 cm.
Advances in Urology, 2012
Background. Extracorporeal shock wave lithotripsy (ESWL) has progressively acquired popularity as being the gold standard treatment for upper urinary tract lithiasis in infants since 1980. Our aim was to evaluate the outcome of ESWL for kidney stones and the use of double-J stent in infants. Material and Methods. A prospective clinical trial study performed on 50 infants with renal calculi at pelvic admitted in the Urology ward of Shafa Hospital, Sari, Iran, between 2001 and 2010. Main outcome measure of our study was clearing stones after one or more consecutive sessions of ESWL. Results. The study included 50 patients with renal calculi at pelvic. Among them, there were 35 (70%) boys and 15 (30%) girls with the age ranging from 1 to 13 months (mean of 7 month ± 3 days). All of them were treated by standard ESWL using Simons Lithostor plus machine. The stone sizes ranged from 6 mm to 22 mm. Double-J stents were placed in 11 infants (22%) with stones larger than 13 mm. Most of the patients required only one ESWL session. Conclusion. Since there were no complications following ESWL treatment, we can conclude that, in short term, ESWL is an effective and safe treatment modality for renal lithiasis in infants. In addition, we recommend double-J stent in infants with stones larger than 13 mm.
Journal of Urological Surgery, 2021
Factors that may influence the efficiency and reliability of shock wave lithotripsy have been examined in the treatment of stone disease in patients aged 0-2. Materials and Methods: The data of 149 patients treated with shock wave lithotripsy in our clinic between the ages of 0 and 2 years were evaluated retrospectively. Factors for predicting success in terms of overall stone-free rate were analyzed using univariate and multivariate analyses. Results: The mean age of the group was 14.39±4.56 months. The stone-free status was achieved in 102 (70.5%) patients in the first session, 15 (65.2%) of 23 patients in the second session, and 2 (50%) of 4 patients in the third session. Thus, 122 (81.9%) of the children were stone-free after shock wave lithotripsy at an average of 10.01±11.34 months of follow-up. The mean stone size was 8.66±3.47 mm. Moreover, smaller stone size and single stones were found to be significant predictors of treatment success (p=0.007 and p≤0.001, respectively). Additionally, it was determined that the single number of stones had a positive effect on treatment success in multivariable analysis (area under the curve=0.683, p=0.002). There were no major complications observed. Conclusion: Our study has shown that shock wave lithotripsy can be used with high success and low morbidity in the treatment of urinary system stone disease in children aged 0-2, especially in the presence of a single stone.