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The effect of intracalyceal distribution on the clearance of renal stones of ≥ 20 mm in children after extracorporeal lithotripsy
Author(s) -
Ather M.H.,
Noor M.A.,
Akhtar S.
Publication year - 2004
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/j.1464-410x.2003.04739.x
Subject(s) - medicine , extracorporeal shock wave lithotripsy , lithotripsy , surgery , renal pelvis , renal colic , ureter , alternative medicine , pathology
In this section there are five papers covering a range of topics. Authors from Pakistan, Hong Kong, England, Greece, Canada and Turkey have written about different issues: intra‐calyceal distribution, dynamic MR urography to assess drainage in dilated pelvicalyceal systems, perineal pain after enterocystoplasty in bladder exstrophy, PSA assessment in childhood, and the use of video‐urodynamics in managing non‐neurogenic voiding dysfunction. OBJECTIVES To determine the effect of the intracalyceal distribution of renal stones on clearance rates after treating paediatric nephrolithiasis with extracorporeal shock wave lithotripsy (ESWL). PATIENTS AND METHODS We assessed a retrospective case series of children (aged ≤ 14 years) undergoing lithotripsy on an MPL 9000 (Dornier GmbH, Germany) echo‐guided lithotripter. Patients were identified using an international coding and indexing system and ESWL registry. In all, 125 children were treated during 1990–2003, but 21 had stones of ≥ 20 mm. Stone clearance was assessed at 1 and 3 months, the stone‐free state being defined as no radiological evidence of stone or fragments of ≤ 3 mm. Failed treatments were analysed to identify any correlation with stone site. RESULTS The overall stone‐free rate was 81%; in four children the treatment failed (all girls) and subsequently they required ancillary procedures. Nineteen patients (90%) received up to three sessions of ESWL; two required four or more sessions. Of the four children in whom treatment failed, two had JJ stents; the stones were in the lower pole calyx in two, and the renal pelvis and lower pole calyx in two. The mean stone size in those where treatment failed was 25 mm, vs 21 mm in the stone‐free group. The complication rate was 19%, but only one child required admission to hospital. CONCLUSIONS ESWL is very effective for renal stones in children, with minimal morbidity. Lower pole and partial staghorn stones with a major component in the lower pole calyx should preferably be treated by a percutaneous approach.