title: Extracorporeal shock wave lithotripsy as first line treatment alternative for urinary tract stones in children: a large scale retrospective analysis.
abstract: OBJECTIVE
  Management of urinary tract stones in children represents a challenging problem. In this study we retrospectively analyzed our experience with extracorporeal shock wave lithotripsy (SWL) in children.
  
  
  METHODS
  During a 12-year period 408 urinary tract calculi in 344 children (mean age 8.7 +/- 3.9 years, range 6 months to 14 years) were managed with the Lithostar Plus lithotriptor (Siemens Medical Systems, Iselin, New Jersey). There were 57 caliceal stones, 167 in the renal pelvis, 31 in the proximal ureter, 16 in the mid ureter and 121 in the distal ureter, and 16 bladder stones.
  
  
  RESULTS
  All patients were treated on an outpatient basis, with intravenous sedation being used in 138 (40.1%), general anesthesia in 132 (38.4%) and no anesthesia in 74 (21.5%). A maximum of 3,500 shocks and 18 kV per session was given. A total of 780 SWL sessions were applied (mean 1.9 sessions per stone). Overall, a stone-free rate of 79.9% and clinically insignificant residual fragments in 13.2% of cases were observed at 3-month followup with a re-treatment rate of 53.9%. Overall efficacy quotient was 50.9%. Significantly more favorable results were achieved in ureteral calculi and stones 2 cm or smaller (p <0.05). Complications were observed in 33 patients (9.6%).
  
  
  CONCLUSIONS
  Our results indicate that SWL, with satisfactory stone-free rates and efficacy quotients in stones 2 cm or smaller can be offered as a first line treatment in children.
authors.affiliation: Department of Urology, Haseki Teaching and Research Hospital, Istanbul, Turkey.
authors.forename: Ahmet Yaser
authors.initials: AY
authors.lastname: Muslumanoglu
authors.forename: Ahmet
authors.initials: A
authors.lastname: Tefekli
authors.forename: Omer
authors.initials: O
authors.lastname: Sarilar
authors.forename: Murat
authors.initials: M
authors.lastname: Binbay
authors.forename: Faith
authors.initials: F
authors.lastname: Altunrende
authors.forename: Unsal
authors.initials: U
authors.lastname: Ozkuvanci
mesh_terms: D000293:Adolescent; D000553:Ambulatory Care; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008096:Lithotripsy / Q000009:adverse effects; D008297:Male; D019233:Retreatment; D012189:Retrospective Studies; D016896:Treatment Outcome; D014545:Urinary Calculi / Q000628:therapy*