The aim of our study is to determine the efficacy and safety of extrac
orporeal shock wave lithotripsy (ESWL) as a method of treatment of nep
hrolithiasis in childhood. Between 1986 and 1994, 50 children with ren
al calculi were treated by ESWL in our department. The age of the chil
dren ranged from 8 months to 14 years. Thirty-three of them were boys
and 17 girls. The stone location was in the renal pelvis in 38 cases,
in the upper renal calyx in 4 cases, in the lower calyx in 2, while 6
children had staghorn calculi. The stone size ranged between 3 and 39
mm. All treatments were performed with Dornier HM4 except 12 children,
all older than 10 years, who underwent ESWL with Dornier HM3. AU ESWL
procedures took place under general anesthesia or sedation with ketam
ine. The number of shock waves varied between 400 and 2,000 per treatm
ent and the standard maximum generator voltage was 18 kV. The overall
stone clearance rate at 1 month was 66%. Fourteen children with large
residual fragments underwent a second ESWL procedure 3 months later. W
ith a mean follow-up of 33 months, 41 children (82%) are stone-free. T
en children developed urinary tract infection and 5 Steinstrasse. Twel
ve children had a pre- and post-ESWL DMSA scan and no permanent impair
ment of renal function was observed. We conclude that ESWL is the trea
tment of choice for urinary tract lithiasis in childhood. It is a low-
risk method, without serious complications, which yields as high a suc
cess rate in children as in adults. We believe that as the stone fragm
entation and clearance is much higher in children that in adults, the
method must be the initial approach and may be the monotherapy even in
staghorn or complex stones.