title: Ultrasound-Guided Shockwave Lithotripsy Reduces Radiation Exposure and Has Better Outcomes for Pediatric Cystine Stones.
abstract: Background/Aims/Objectives: To evaluate the outcomes and ionizing radiation (IR) exposure of children with cystine stones (CS) using different shockwave lithotripsy (SWL) guidance modalities.
  
  
  METHODS
  Data from pediatric patients with renal stones treated between January 2009 and August 2015 were retrospectively reviewed. Outcome results and IR exposure in patients undergoing fluoroscopy (FL)-guided SWL and ultrasonography (US)-guided SWL were compared. First-time stone formers and those treated with SWL and with complete follow-up data, including post-treatment stone analysis confirming CS were included.
  
  
  RESULTS
  Forty-four patients (16 girls and 28 boys) met the inclusion criteria. Results of SWL performed in 51 kidneys were analyzed. After the SWL, 41 (80.4%) of 51 kidneys were stone free, and 10 (19.6%) had clinically insignificant residual fragments (≤3 mm) or unfragmented stones. The success rates differed between patients in Group-FL (60%) and Group-US (93.5%) (p = 0.008). Single-session success rates were higher, and prospects of retreatment were lower in Group-US (p = 0.000 and p = 0.002, respectively). In addition, overall complications were significantly lower in Group-US (p = 0.042). Overall IR exposure was higher in Group-FL (p = 0.013).
  
  
  CONCLUSIONS
  US-guided SWL is more effective for pediatric CS and should be considered a preferred treatment to reduce IR doses in children.
authors.affiliation: Department of Urology, Baskent University Adana Dr. Turgut Noyan Medical and Research Center, Adana, Turkey.
authors.forename: Mehmet Resit
authors.initials: MR
authors.lastname: Goren
authors.forename: Vinil
authors.initials: V
authors.lastname: Goren
authors.forename: Cevahir
authors.initials: C
authors.lastname: Ozer
mesh_terms: D002648:Child; D002675:Child, Preschool; D003553:Cystine / Q000737:chemistry*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007669:Kidney Calculi / Q000628:therapy*; D008096:Lithotripsy; D008297:Male; D000069079:Radiation Exposure / Q000517:prevention & control*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014463:Ultrasonography; D014514:Ureteral Calculi / Q000628:therapy
chemical_list: D003553:Cystine
keywords: Cystine; Cystinuria; Lithiasis; Lithotripsy; Pediatrics; Radiation