FIRST AND 2ND GENERATION LITHOTRIPSY IN CHILDREN - RESULTS, COMPARISON AND FOLLOW-UP

During a 5-year period 32 children and adolescents 4 to 18 years old u nderwent 35 extracorporeal shock wave lithotripsy (ESWL) treatments fo r 37 calculi. The unmodified Dornier HM3 lithotriptor was used in 21 c ases (60%) while the remaining cases were treated with the Siemen Lith ostar lithotriptor. The HM3 necessitated general anesthesia in 67% of patients and the Lithostar necessitated intravenous sedation in 86%. T he majority of pediatric lithotripsy treatments were performed on an o utpatient basis (24) or during an overnight hospital stay (3) while 8 were done on an inpatient basis. Of the 37 stones treated with 1 ESWL session 68% resolved, 19% had residual fragments less than 4 mm., 8% h ad residual fragments greater than 4 mm. and 5% required an endoscopic procedure for resolution. When success rates by lithotriptor were exa mined no significant difference between the 2 machines was identified although the HM3 treated larger stones (p = 0.0499). There were no sta tistical differences in regard to success and the use of stents, patie nt age or stone location between the 2 lithotriptors. Three patients r equired adjuvant procedures, and complications and morbidity developed in 2 and 5, respectively. All children or parents were contacted for followup (range 7 to 67 months). One child required ESWL for a new sto ne while another passed a stone without intervention. Only 1 child wit h a residual fragment less than 4 mm. became symptomatic but needed no intervention while 1 of 3 with fragments greater than 4 mm. needed in tervention. No patients required open or percutaneous intervention.