Safety of shock wave lithotripsy for treatment of pediatric urolithiasis: 20-year experience.
OBJECTIVE
This retrospective study was designed to assess the impact of shock wave lithotripsy on the pediatric kidney using pretreatment and posttreatment (99m)technetium dimercapto-succinic acid renal scintigram.


METHODS
A total of 182 patients 5 months to 19.8 years old (mean 5.3 years) were treated for renal calculi with shock wave lithotripsy during a 20-year period. Pretreatment evaluation included clinical assessment, urine culture, renal ultrasound and plain abdominal radiograph with or without excretory urogram. Dimercapto-succinic acid scintigram was performed before and 6 months after completion of treatment in 94 patients (52%).


RESULTS
Patients underwent 1 to 4 sessions of shock wave lithotripsy per kidney with at least 1 month between treatments. Median number of shocks delivered per session was 3,000 (IQR 2,601 to 3,005). No new scars were observed on any posttreatment dimercapto-succinic acid scan. Regarding renal function, patients fell into 1 of 4 groups. Group 1 (66 patients, 70%) had normal function on dimercapto-succinic acid scan before and after treatment, group 2 (18, 19%) had decreased function in the affected kidney on pretreatment scan with no change after treatment, group 3 (2, 2%) had impaired function in the treated kidney that was transient (1) or permanent (1) and group 4 (7, 7%) had improved function in the treated kidney.


CONCLUSIONS
Shock wave lithotripsy is an effective treatment for renal calculi in children. Renal parenchymal trauma associated with extracorporeal shock wave lithotripsy does not seem to cause long-term alterations in renal function or development of permanent renal scars in children.
Griffin
Stephen J
SJ
Pediatric Surgery Service, Necker Hospital for Sick Children, Paris, France.
Margaryan
Marc
M
Archambaud
F
F
Sergent-Alaoui
A
A
Lottmann
Henri B
HB
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D007669:Kidney Calculi / Q000000981:diagnostic imaging / Q000628:therapy*; D008096:Lithotripsy; D011877:Radionuclide Imaging; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult