Extracorporeal shock wave lithotripsy in children: equivalent clearance rates to adults is achieved with fewer and lower energy shock waves

Abstract

To compare the outcome, safety and efficiency of extracorporeal shock wave lithotripsy (ESWL) using an electromagnetic lithotripter for upper urinary tract stones in children and adults. We retrospectively reviewed data over a 5-year period for patients with solitary, renal and upper ureteric stones measuring <2 cm in whom ESWL was the treatment method. Group A consisted of 44 children (mean [SD] age 5.9 [4.4] years) and group B of 562 adults (mean [SD] age 40.9 [13.1] years). The number and energy of SWs used was not predetermined and was tailored until adequate fragmentation was achieved. Initial stone reassessment was performed at 48 h and monthly thereafter. The number of SWs, intensity of SWs, stone-free rate, auxiliary procedure rate, re-treatment rate, complication rate and effectiveness quotient (EQ) were assessed in each group. The stone-free rate with ESWL was 84% in children and 87% in adults (P = 0.78). The EQ was 77% and 75% in children and adults, respectively (P = 0.56). The mean (sd) number of SWs and energy required per session was 950 (349) and 11.83 (0.48) kV in children and 1262 (454) and 12.36 (0.34) kV in adults (P < 0.001). The re-treatment, auxiliary procedure and complication rates were similar in both groups. ESWL is as safe and effective in children as in adults for solitary renal and upper ureteric stones that are <2 cm. Children required significantly fewer and lower energy SWs to achieve equivalent results.