title: Predictive factors and management of steinstrasse after shock wave lithotripsy in pediatric urolithiasis--a multivariate analysis study.
abstract: OBJECTIVE
  To define the predictive factors for the formation of steinstrasse (SS) after shock wave lithotripsy (SWL) and determine the treatment strategies for this complication in pediatric urolithiasis.
  
  
  METHODS
  We retrospectively reviewed the data of 341 renal units (RUs) treated with SWL for urolithiasis. The stone location, stone burden, auxiliary procedures, energy level, and number of shock waves were recorded. Statistical analysis was performed to detect the predictive factors for the formation of SS. In addition, the treatment of children with SS was evaluated.
  
  
  RESULTS
  The mean age of the children was 8.31 years (range 1-17). Episodes of SS developed in 26 RUs (7.6%). Of the 26 RUs, 20 (77%) were localized in the lower, 5 (19%) in the upper, and 1 (4%) in multiple locations in the ureter. The stone burden was the only statistically significant factor predicting the formation of SS on logistic regression analysis (P = .001). Of the 26 RUs, 17 (65.4%) were successfully managed by repeat SWL monotherapy, 4 (15.4%) were managed with ureteroscopy after failure of SWL, 1 (3.8%) was managed by ureteroscopy monotherapy, and 4 (15.4%) were monitored with conservative management with antispasmodic drug plus hydration therapy. The mean number of SWL sessions was 1.72.
  
  
  CONCLUSIONS
  The incidence of SS development in children after SWL treatment was similar to that in adult series. Our results suggest that the stone burden is a significant predictive factor for the development of SS after SWL in pediatric urolithiasis. Most children with SS could be easily and safely treated by repeat SWL.
authors.affiliation: Department of Urology, University of Istanbul Cerrahpasa Medical Faculty, Istanbul, Turkey. bulonal@yahoo.com
authors.forename: Bulent
authors.initials: B
authors.lastname: Onal
authors.forename: Sinharib
authors.initials: S
authors.lastname: Citgez
authors.forename: Nejat
authors.initials: N
authors.lastname: Tansu
authors.forename: Cetin
authors.initials: C
authors.lastname: Demirdag
authors.forename: Cagatay
authors.initials: C
authors.lastname: Dogan
authors.forename: Burcu
authors.initials: B
authors.lastname: Gonul
authors.forename: Oktay
authors.initials: O
authors.lastname: Demirkesen
authors.forename: Can
authors.initials: C
authors.lastname: Obek
authors.forename: Ahmet
authors.initials: A
authors.lastname: Erozenci
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007223:Infant; D008096:Lithotripsy / Q000009:adverse effects*; D008297:Male; D015999:Multivariate Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D013997:Time Factors; D016896:Treatment Outcome; D014421:Turkey / Q000453:epidemiology; D014517:Ureteral Obstruction / Q000453:epidemiology* / Q000209:etiology; D052878:Urolithiasis / Q000628:therapy*