title: Ungated extracorporeal shock wave lithotripsy: safe and effective in the pediatric population.
abstract: OBJECTIVE
  Ungated extracorporeal shock wave lithotripsy (SWL) is unsynchronized to the patient's electrocardiogram. Although ungated extracorporeal shock wave lithotripsy (SWL) is associated with cardiac arrhythmias in adults, the incidence of arrhythmias in children has not been established. We report on the safety and efficacy of ungated SWL of renal calculi in children.
  
  
  METHODS
  We evaluated all children less than 18 years of age undergoing ungated SWL for renal calculi. Lithotripsy with gradual incremental energy increase was used to treat the stones. Patients were monitored for arrhythmias and other standard monitoring intraoperatively and postoperatively.
  
  
  RESULTS
  Twenty-four consecutive children (10 boys and 14 girls) between 3.5 and 17 years of age underwent 32 ungated SWL procedures for renal calculi. The stone size ranged from 5 mm to 19 mm. No patient had cardiac arrhythmias or other intraoperative complications, required to have the procedure terminated prematurely, or conversion to gated SWL. The overall stone free rate was 87% based on radiographic imaging.
  
  
  CONCLUSIONS
  This series supports our initial series that ungated SWL is safe and efficacious in children less than 18 years of age. The arrhythmias associated with adults do no appear to occur in children undergoing ungated SWL.
authors.affiliation: Center for Pediatric and Adolescent Urology, Glickman Urological and Kidney Institute, Cleveland Clinic Children's Hospital, Cleveland, Ohio 44195, USA.
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Palmer
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007669:Kidney Calculi / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D008096:Lithotripsy / Q000379:methods*; D008297:Male; D011860:Radiography, Abdominal; D016896:Treatment Outcome