EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY

OUTCOME IN PEDIATRIC UROLITHIASIS

Abstract

Aim and Objectives: (1) To determine the efficacy of extra-corporeal shock wave lithotripsy with reference to stone size, site and radiodensity in children. (2) To determine acute early complications during and following extra-corporeal shock wave lithotripsy in children. Study Design: Analytical case series study. Material and Methods: Fifty patients of either sex below the age fourteen (14 years) having renal, ureteric and bladder stones between 5-20 mm in size along with their long axis presented to department of urology Shaikh Zayed Hospital Lahore during the period of one year extending from 02-02-2008 to 02-02-2009 were included in this study. Children with serum creatinine level greater than or equal to 3mg/dl, obstruction distal to the stone, patient with active bleeding disorders, uncorrected hypertension, patient unfit for general anaesthesia, untreated urinary tract infection and patients with gross anatomical anomaly were excluded from study. All the patients were given shock waves under intravenous sedation or general anaesthesia in a standard manner on out door basis. All the children were evaluated for stone clearance and early complications at first 24-72 hours. At the end of three months ESWL treatment was considered successful, if the patients were stone free or had residual fragments 4 mm or less in size. Results: Out of the fifty patients, 40 (80%) were males and 10 (20%) females with male to female ratio of 4.1. The age range of patients was 2-14 years (mean ± SD 9.24±3.48 years). Thirty three patients (66%) had renal stones, 7 (14%) ureteric and 10 patients (20%) had bladder stones. Single successful treatment session was noted in 22 patients (44%), 18 patients (36%) received two sessions and 10 patients (20%) required three sessions for successful stone fragmentation.
Seventeen patients did not show stone clearance even after three sessions within three months follow-up. Twenty one patients (42%) felt pain after lithotripsy session, and they were given injectable analgesia and the pain settled, haematuria in 17 patients (34%), impacted stone in five (10%), ureteric colic and urinary tract infection in three, three cases respectively and only one case developed steinstrasse. Twenty patients
(40%) developed minor complications of anaesthesia, like nausea, vomiting which relieved with injectable antiemetics.