Extracorporeal shockwave lithotripsy in the pediatric population

Background: Shockwave lithotripsy (SWL) is being used increasingly as a the rapeutic modality for childhood urolithiasis. We reported our experience an d results of SWL in the pediatric population. Methods: The 59 renal units (RU) of 54 patients were retrospectively review ed. The mean patient age was 10 +/- 3.5 years. All patients were treated wi th the Lithostar lithotripter in outpatient settings. Those with positive c ulture results were treated under appropriate antibiotic coverage, Seven pa tients were treated under general anesthesia and the rest under sedoanalges ia. Shielding of the lung fields or gonads was not used. For the upper pole stones, protection of the lungs was accomplished by elevating the upper ha lf of the body with supportive pillows, thus moving the kidney away from th e lung fields. Six RUs were catheterized via double-pigtail ureteral cathet ers or by percutaneous nephrostomy tube prior to treatment. The average sto ne load was 1.8 +/- 2.5 cm(2). Results: Patients were treated with an average of 2.5 sessions. A total of 1000 to 2500 shockwaves were delivered between 14.5 and 17.8 kV. Routine sp asmolytic treatment was not initiated. The stone-free rate was 64%, and cli nically insignificant residual fragments (CIRF) were present in 29% of RUs; thus, the success rate was 93%, Fever that necessitated hospitalization oc curred in one patient. No other complications were seen except skin bruisin g and early hematuria. Conclusion: Shockwave lithotripsy is a safe and effective treatment modalit y for childhood stones of appropriate size and radiologic characteristics.