Lithotripsy in children. Multicentre study of the Paediatric Urology StudyGroup.

The authors present the results of a survey conducted among French paediatr ic urologists belonging to the Groupe d'Etudes en Urologie Pediatrique (GEU P) (Paediatric Urology Study Group). This study, based on 122 cases observe d in 13 centres, is not exhaustive, but is nevertheless statistically signi ficant. The preoperative assessment confirms the usual findings of urinary stones in children: pyelonephritis, haematuria and abdominal pain, the usua l presenting complaint, concomitant malformative uropathy (10% of cases) an d a predominance of calcium stones. More than 200 stones were treated, larg er than 10 millimetres in diameter in one-third of cases. Renal stones, mai nly caliceal (more than 50%), included 11 staghorn calculi. This study also included 22 ureteric stones, mainly in the pelvic ureter, and 2 bladder st ones. Lithotripsy was ultrasound-guided in 2/3 of cases and required genera l anaesthesia in about 3/4 of cases. Ureteric catheterization was required in 19 infants preoperatively, but in only 2 infants (stein strasse) postope ratively. One or two lithotripsy sessions were sufficient in most cases, bu t 4 sessions were necessary in 5 patients, to the same kidney in 1 case. Th e mean hospital stay was 2 to 3 days, but the procedure was performed on an outpatient basis in 15 cases. The immediate postoperative course was uneve ntful and asymptomatic. This survey revealed about 10% of complete failures , corresponding to solitary caliceal stones in 2/3 of cases; 29 partial fai lures were essentially due to lower caliceal stones and staghorn calculi; 8 4 successes (stone-free), mainly pelvic or simple caliceal stones. Scintigr aphy did not reveal any immediate postoperative impairment of renal functio n. This study reported a success rate of about 70 %, regardless of the type of apparatus used. Assessment of the results of ESWL requires sufficient f ollow-up both concerning the outcome of fragmented stones and evaluation of possible functional repercussions. This survey defines the main indication s: although ESWL can be applied to most stones, some stones constitute poor indications (cystine stones, stenotic malformative uropathy) or dubious in dications: small lower caliceal stones, densely calcified staghorn calculi in older children. This study confirmed the efficacy and low morbidity of E SWL in children. A prospective study needs to be conducted according to a r igorous protocol in order to refine the technique and indications while red ucing the possible long-term risks.