CHILDHOOD UROLITHIASIS - UROLOGICAL MANAGEMENT OF UPPER TRACT CALCULIIN THE ERA OF EXTRACORPOREAL SHOCK-WAVE LITHOTRIPSY

Objective: To evaluate the management of urolithiasis in children sinc e the development of extracorporeal shock-wave lithotripsy (ESWL). Met hods: Between 1988 and 1994, 37 children, aged from 2 to 15 years (mea n 10), with upper tract urolithiasis were evaluated and treated. Litho genic metabolic disorders or anomalies of the urinary tract were prese nt in 11 children (30%). Urolithiasis was multiple in 9 cases and bila teral in 2 cases. A total of 47 renal (30) or ureteral (17) stones wer e managed, of which 5 were partial or complete staghorn calculi. Initi al treatment was surgery in 4 cases (1 nephrectomy, 1 partial nephrect omy and 2 pyelolithotomies) and piezoelectric ESWL in 43 cases. Result s: The overall ESWL success rate was 82.2%, with auxiliary endoscopic procedures in 3 cases. ESWL failures required surgical stone removal i n 5 cases, endoscopic ureterolithotripsy in 1 case and electrohydrauli c ESWL in 1 case. Residual fragments after pyelolithotomies were also treated by ESWL. Conclusion: ESWL is the mainstay of treatment of chil dhood upper tract urolithiasis, but other therapeutic methods retain s pecific indications. Its application requires great vigilance and its long-term effects are uncertain. It is therefore important to rule out any underlying pathology and where possible to prevent further stone formation.