Extracorporeal shock wave lithotripsy in children. A study of efficacy andevaluation of renal parenchymal damage by DMSA-Tc99m renal scan: a study of 39 children

Aim. - The objectives of the study were to confirm the efficacy of extracor poreal shock wave lithotripsy (ESWL) in infants and children and to evaluat e potential long-term renal parenchymal damage by 99m Tc DMSA renal scan. Materials and methods, - Between November 1989 and November 1997, 39 childr en between 10 months and 17-1/2 years of age (average: 7 years) were treate d by extracorporeal shack wave lithotripsy for kidney or ureteral stones wi th a Sonolith 3000 lithotriptor (Technomed Corp). Forty-six stones were tre ated. Eight metabolic and 11 urological abnormalities were identified. The evaluation of the treatment and its consequences were based on a clinical e xamination, conventional imaging and a DMSA renal scan performed 24 h befor e extracorporeal shock wave lithotripsy and at least 6 months after treatme nt Results, - Treatment,vas successful (stone fragmented and eliminated) in 84 .6% at 3 months after one to four sessions. Sixty-one sessions were necessa ry and two patients underwent open surgery for failed extracorporeal shock wave lithotripsy. Three recurrences were also retreated. At long term follo w-up (6 months to 8 years) no incidents of high blood pressure were observe d, nor parenchymal lesions imputable to extracorporeal shock wave lithotrip sy. Conclusions. - The efficacy of the extracorporeal shock wave lithotripsy fo r children is proven. This study also confirms the innocuousness of extraco rporeal shock wave lithotripsy for renal parenchyma even in infants. Howeve r, long term follow-up and further evaluation with the other categories of lithotriptors are necessary to make definitive conclusions. (C) Elsevier, P aris.