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P. Caione, E. Matarazzo, S. BattagliaREFERENCES1. D’Addessi A, Bongiovanni L, Sasso F, Gulino F, Falabella R, BassiP. Extracorporeal shockwave lithotripsy in Pediatrics. J Endourol2008; 22:1-11.2. Dogan HS, Tekgul S. Management of pediatric stone disease. CurrUrol Rep 2007; 8:163-73.3. De Dominicis M, Matarazzo E, Capozza N, Collura G, Caione P.Retrograde ureteroscopy for distal ureteric stone removal in children,BJU Int 2005; 95:1049-52.4. Ozden E, Sahin A, Tan B, Dogan HS, Eren MT, Tekgul S.Percutaneous renal surgery in children with complex stones. J PedUrol 2008; 4:295-298.5. Desai MR, Kukreja RA, Patel SH, Pabat SD. Percutaneousnephrolithotomy for complex pediatric renal calculus disease. JEndourol 2004; 18:24-27.6. Caione P, De Gennaro M, Capozza N, et al. Endocopic manipulationof ureteral calculi in children by rigid operative ureterorenoscopy.J Urol 1990; 144:484-485.CorrespondencePaolo Caione, MDProfessor Div. of Urology“Bambino Gesù” Children’s HospitalPiazza S. Onofrio, 4 - 00165 Rome, Italycaione@opbg.netEnnio Matarazzo, MDDiv. of Urology“Bambino Gesù” Children’s HospitalPiazza S. Onofrio, 4 - 00165 Rome, Italymatarazzo@opbg.netDr. Sandra BattagliaDiv. of Urology“Bambino Gesù” Children’s HospitalPiazza S. Onofrio, 4 - 00165 Rome, Italysandra_battaglia@yahoo.co.uk48Archivio Italiano di Urologia e Andrologia 2010; 82, 1
PRESENTATIONExtracorporeal shock wave lithotripsyfor the treatment of urinary stones in children.Marco Castagnetti, Wiafro RigamontiSection of Paediatric Urology, Urology Unit, Department of Oncological and Surgical Sciences,University Hospital of Padova, Padua, ItalySummaryObjective: To provide the reader with an overview about the role of shock wavelithotripsy (SWL) in the management of urinary stones in children, and the complicationsassociated with the procedure.Material and methods: We performed a non-systematic review of the English literatureto ascertain the success rate of SWL, the need for ancillary procedures such as stentingof the urinary tract or endoscopic manipulation, and the possible side effects and complicationsof the procedure.Results: Both renal and ureteric stones can be amenable to SWL. The latter can be performedin patients of any age including low birth weight infants. Paediatric series of SWL report 3-month stone-free rates of 70 to 100%. High rates can be achieved also dealing with large stonesof 20-30 mm in diameter, staghorn calculi and stones located in the lower-pole. Current dataseem to suggest that systematic preoperative insertion of ureteric stents is unnecessary. Afterthe procedure, complications occur in about 20% of cases and include haematuria, steinstrasse,ureteric obstruction, and urinary tract infection with or without fever. Most of these complicationsare self-limiting and require only medical treatment. Haematoma formation is exceptionalafter SWL and the procedure does not seem to damage long-term renal growth and function,or cause any damage to the surrounding anatomical structures.Conclusion: Data from current literature warrant an attempt of treatment of urinary stones bySWL in many paediatric cases including very young patients, patients with big stones or stonesin lower-poles, and patients with staghorn calculi. The procedure seems to be safe.KEY WORDS: Urolithiasis; Lithotripsy; Children.Submitted 9 May 2009; Accepted 30 June 2009INTRODUCTIONUrinary stones have been reported to affect 0.1 to 5% ofchildren and to account for up to 1 in 1000 hospital admissions.Due to the high compliance of the urinary tract,children are considered to pass stones more easily thanadults. This warrants an initial conservative managementof many paediatric cases with stone disease and a moreliberal use of extra-corporeal shock wave lithotripsy(SWL) in children than adults. We aimed here to reviewthe success rate of SWL, the need for ancillary peri-operativeprocedures such as stenting of the urinary tract orendoscopic manipulation, and the possible side effectsand complications of the procedure.MATERIAL AND METHODSWe performed a non-systematic review of the English literaturein June 2008 via the databases MEDLINE/PubMedand EMBASE using the Medical Subjects Headings(MeSH) “urolithiasis” and “child” retrieved from the MeSHbrowser provided by MEDLINE.Outcomes assessed included success rate of SWL, needfor ancillary procedures such as stenting of the urinarytract, and possible side effects and complications of theprocedure.RESULTSBoth renal and ureteric stones in patients of any age canbe amenable to SWL. The procedure can generally beperformed with the patient under sedation. Indeed, themost severe complications reported after SWL were actuallyrelated to the general anaesthesia including laryngospasmand haemoptysis.Ultrasound focusing is usually possible for renal stones,Archivio Italiano di Urologia e Andrologia 2010; 82, 149
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