title: Safety of ungated shockwave lithotripsy in pediatric patients.
abstract: OBJECTIVE
  Ungated extracorporeal shockwave lithotripsy (ESWL) in adults is associated with cardiac arrhythmias. We report on the safety and efficacy of this method for treatment of renal calculi in children.
  
  
  METHODS
  Children under 14 years with radio-opaque renal stones were treated by ungated ESWL. Pre-treatment plain radiographs and intravenous urography and post-treatment ultrasonography and plain films were used to follow up clearance of fragments. All children were monitored for arrhythmias.
  
  
  RESULTS
  Thirty-seven children (28 males, nine females) with a median age of 5 years (range 2-14 years) underwent 69 ungated ESWL sessions for renal calculi. Nineteen children had stones located in the left kidney, 17 had stones located in the right kidney and one child had bilateral renal stones. The stone size ranged from 6 to 25 mm (mean 9.9 mm). Shockwave number ranged from 800 to 3650 (mean of 2500 shockwaves per session). All children underwent lithotripsy with a gradual incremental energy increase from 14 to 20 kV. No patient had cardiac arrhythmias or other intra-procedural complications. No patient required conversion to gated ESWL. The overall stone-free rate was 86%.
  
  
  CONCLUSIONS
  The results suggest that ungated ESWL is safe in children under 14 years. The efficacy was comparable to that of gated ESWL from previously published series.
authors.affiliation: Division of Pediatric Urology, Aboul-Riche Children's Hospital, Cairo University, Cairo, Egypt.
authors.forename: Ahmed M
authors.initials: AM
authors.lastname: Shouman
authors.forename: Islam A
authors.initials: IA
authors.lastname: Ghoneim
authors.forename: Ahmed
authors.initials: A
authors.lastname: ElShenoufy
authors.forename: Ali M
authors.initials: AM
authors.lastname: Ziada
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001145:Arrhythmias, Cardiac / Q000175:diagnosis / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007669:Kidney Calculi / Q000628:therapy*; D008096:Lithotripsy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D012449:Safety; D016896:Treatment Outcome