Effect of size and site on the outcome of extracorporeal shock wave lithotripsy of proximal urinary stones in children.
OBJECTIVE
To determine the effect of location and size of stones on the outcome of extracorporeal shock wave lithotripsy (ESWL) in children.


METHODS
In 2008-2010, 150 children (median age 6.6 years) with radio-opaque ureteric and renal stones measuring ≤4 cm were treated. Exclusion criteria were coagulation disorders, pyelonephritis, distal obstruction, non-functioning kidney and hypertension. ESWL was performed under general anesthesia. Follow up period was 5-22 months.


RESULTS
186 stones were treated: 76 calyceal, 92 pelvic and 18 proximal ureteral. Mean stone size was 1.3 cm. A total of 312 sessions were performed (mean per stone = 1.67 sessions). The mean number of shock waves per session was 2423.68. Overall stone-free rate was 89.24%. Having a calyceal location did not significantly affect the stone-free rate (p = 0.133). The failure rate was significantly higher (66.7%) in stones >3 cm in size (p < 0.001). Complications were encountered in 18 patients; 2 underwent auxillary ureteroscopy and 4 uretrolithotomy for treatment of steinstrasse.


CONCLUSIONS
ESWL is a safe and effective method for treatment of stones up to 2 cm in children. Rate of auxillary procedures increases in stones >2 cm in size. About 80% of failures were associated with stone size >1.35 cm while 52.3% of completely cleared stones were associated with size <1.35 cm.
Division of Pediatric Urology, Aboul-Riche Children's Hospital, Cairo University, Cairo, Egypt.
Enmar I
EI
Habib
Hany A
HA
Morsi
Mohammed S
MS
Elsheemy
Waseem
W
Aboulela
Mohamed A
MA
Eissa
D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007669:Kidney Calculi / Q000601:surgery; D008096:Lithotripsy; D008297:Male; D012372:ROC Curve; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D014514:Ureteral Calculi / Q000601:surgery; D014545:Urinary Calculi / Q000473:pathology* / Q000601:surgery*