Limitations of extracorporeal shock wave lithotripsy for urinary tract calculi in young children

Abstract

Despite success rates with a variety of urinary tract calculi, there is growing concern that extracorporeal shock wave lithotripsy (ESWL) has limitations and that its role needs to be redefined. We report the outcome of 28 consecutive children (age range, 6.5 months to 7 years; mean, 3.6 years) with urinary calculus disease, treated over a 5-year period. Thirteen patients had ESWL monotherapy, and 8 achieved stone clearance. The other 5 children in the ESWL monotherapy group, all with multiple calculi, required surgery to render them stone free. A further 14 patients (6 staghorn calculi, 6 multiple calculi, 1 solitary renal, and 1 child with multiple bladder calculi) were considered unsuitable for ESWL and had primary surgery. Twelve of those 14 were cleared by open surgery, one had residual fragments successfully treated by ESWL, and one still awaits adjuvant ESWL. One child had a solitary renal calculus (5 mm) which passed spontaneously. This study demonstrates that ESWL monotherapy cleared stones in only 8 of 28 patients and clearance in a further 6 was achieved with surgery. Surgery will continue to play an important role in the management of paediatric urolithiasis for large staghorn, multiple urinary tract calculi and lithotripsy failures.