title: Extracorporeal shock wave lithotripsy in prepubertal children: 22-year experience at a single institution with a single lithotriptor.
abstract: OBJECTIVE
  The sophistication of percutaneous nephrolithotomy and ureteroscopy challenges the efficacy of ESWL for urolithiasis in prepubertal patients. We evaluated our long-term experience with ESWL in these patients and determined its efficiency.
  
  
  METHODS
  We retrospectively reviewed the charts of all prepubertal patients who underwent ESWL. We evaluated the need for tubing, the 3-month stone-free rate, the need for additional ESWL, and the effect of stone size and location, and cystinuria on the 3-month stone-free rate.
  
  
  RESULTS
  Between 1986 and 2008, 119 males and 97 females with a mean age of 6.6 years who had urolithiasis underwent ESWL using the Dornier HM3 lithotriptor. We treated 157 children with renal calculi with an average +/- SD diameter of 14.9 +/- 8.9 mm, of whom 66 (42%) required a tube in the urinary system. The 3-month stone-free rate was 80% and 31 patients (19.7%) needed an additional procedure. Stone location did not affect the stone-free rate but stone size did. We treated 59 patients for ureteral stones with an average stone length of 9.5 +/- 4.8 mm, of whom 41 (69%) required tube insertion. The 3-month stone-free rate was 78% and 13 patients (22%) needed an additional procedure. The 3-month stone-free rate did not depend on stone location or size. The rate was 37.5% in patients with cystinuria and 82.5% in all others (p <0.0001). Six patients (2.8%) had complications.
  
  
  CONCLUSIONS
  The 3-month stone-free rate after ESWL in prepubertal patients is 80% and 20% of patients require additional procedures. ESWL is most effective for kidney stones less than 11 mm. ESWL has inferior results for cystine stones compared to other calculi. Complications are rare.
authors.affiliation: Pediatric Urology Unit, Hadassah Hebrew University Medical Center, Jerusalem, Israel. hezil@ekmd.huji.ac.il
authors.forename: Ezekiel H
authors.initials: EH
authors.lastname: Landau
authors.forename: Ofer Z
authors.initials: OZ
authors.lastname: Shenfeld
authors.forename: Dov
authors.initials: D
authors.lastname: Pode
authors.forename: Amos
authors.initials: A
authors.lastname: Shapiro
authors.forename: Shimon
authors.initials: S
authors.lastname: Meretyk
authors.forename: Giora
authors.initials: G
authors.lastname: Katz
authors.forename: Ran
authors.initials: R
authors.lastname: Katz
authors.forename: Mordechai
authors.initials: M
authors.lastname: Duvdevani
authors.forename: Benjamin
authors.initials: B
authors.lastname: Hardak
authors.forename: Helio
authors.initials: H
authors.lastname: Cipele
authors.forename: Guy
authors.initials: G
authors.lastname: Hidas
authors.forename: Vladimir
authors.initials: V
authors.lastname: Yutkin
authors.forename: Ofer N
authors.initials: ON
authors.lastname: Gofrit
mesh_terms: D002648:Child; D002675:Child, Preschool; D005260:Female; D006268:Health Facilities; D006801:Humans; D007223:Infant; D007669:Kidney Calculi / Q000628:therapy*; D008096:Lithotripsy; D008297:Male; D012189:Retrospective Studies; D013997:Time Factors; D014514:Ureteral Calculi / Q000628:therapy*