Safety and efficacy of extracorporeal shock wave lithotripsy in infants
McLorie A. Gordon; Pugach Jeff; Pode Dov; Denstedt John; Bagli Darius; Meretyk Shimon; DA Honey John R.; Merguerian A. Paul; Shapiro Amos; Khoury E. Antoine; Landau H. Ezekiel;
Division of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada
PURPOSE: Extracorporeal shock wave lithotripsy (ESWL) in older children appears to have comparable results when compared to adults, no study has focused on its use in younger children. We reviewed our ESWL experience in children under age 3.5 years to evaluate its safety, and define optimal treatment parameters.
METHODS: We retrospectively reviewed consecutive medical and diagnostic imaging records from three ESWL centers, pertaining to 34 children under 3.5 years of age (36 renal units-RU). The children were from two distinct populations served exclusively by the three centers. We analyzed patient presentation, etiology, age, weight, stone size, preoperative interventions, energy settings, number of shock waves, number of treatments, success (stone fragments < 2 mm), and complications. We performed all forty-nine procedures under general anesthesia and modified the Dornier MFL 5000 table and the Dornier HM3 gantry to improve coupling and localizing of the calculi.
RESULTS: In each population, we noted similar presentations, etiologies, and treatment parameters. Patient age ranged from 6 to 40 months (mean 23.4 months). Stone size ranged from 4 mm to 22 mm diameter (average 13 mm). ESWL parameters included an average of 2210 shocks (range 900-3400) at average of 20.9 kV (range 19 kV-25 kV). Preoperative ureteral stent placement was not shown to be beneficial. Our one and multiple treatment ESWL success rates were 66% and 86%, respectively. No major acute or long-term complications occurred.
CONCLUSIONS: We successfully performed ESWL using treatment parameters similar to adults in 86% of children under 3.5 years without major complications. Modifications of the positioning device improved coupling and localization in smaller patients. Routine preoperative ureteral stenting for large stones is not recommended.