LONG-TERM FOLLOW-UP OF CHILDREN AFTER ESW L - STONE-FREE RECURRENCE RATES, BLOOD-PRESSURE AND RENAL-FUNCTION

Since 1984, 105 ESWL treatments of 65 renoureteral units have been per formed in 56 children (30 boys and 26 girls, age range: 1.5-16 years, mean age: 8.8 years) using the Dornier HM 3 and Storz modulith lithotr ipters. This accounts for about 1% of the ESWL treatments (10 676) per formed during this time period. Associated metabolic disorders had bee n present in 11/56 children (20%), anatomical anomalies in 11/56 child ren (20%) and 34/56 patients (61%) had had recurrent urinary tract inf ection. A total of 29 children (52%) had been stone-free at the time o f discharge from the hospital and 84% three months after ESWL. The fol low-up period ranged from 9 months to 8 years (mean follow-up: 3.8 yea rs). At the time of evaluation, history was taken and blood pressures, serum creatinine, urine culture, KUB, renal ultrasound and/or IVP and MAG 3 or I-123-Hippuran isotope renograms were obtained. During the f ollow-up period, stones had recurred in 8% of the children who had bec ome stone-free after ESWL. In all of the 9 patients (23%), who had not become stone free, regrowth of residual fragments had occurred, 12 ch ildren had been subjected to repeated hospital admissions for stone tr eatment during the follow-up period: 7 children had been treated by re peated ESWL because of residual fragments and stone regrowth (5) or tr ue stone recurrence (2). Percutaneous litholapaxy had been performed i n one girl with cystinuria and staghorn stones. In 4 children with ini tial staghorn calculi and previous stone surgery (2 cases), 4 partial nephrectomies had been performed because of residual stones. One nephr ectomy had been performed in a girl with cystinuria, who did not compl y to stone metaphylaxis. Blood pressures had been normal at the time o f ESWL in all children and remained within their age-specific 5th and 95th percentiles during the follow-up period after ESWL. Total and spl it renal function remained within their age-specific normal ranges. Th e only exception was the girl with an obstructing recurrent cystine st one in the ESWL-treated kidney, who required nephrectomy because of co mplete loss of function.