Extracorporeal shock wave lithotripsy is highly effective for ureteral calculi in children

Purpose: Treatment of ureteral calculi in the pediatric population represen ts a unique challenge. Extracorporeal shock wave lithotripsy (ESWL*) and ur eteroscopy have been advocated for the treatment of such stones. We present our experience with ESWL monotherapy for ureteral stones in children in th e last decade. Materials and Methods: Between 1989 and 1999 we treated 21 boys and 17 girl s with a mean age of 8 years (range 8 months to 14 years) with ureteral sto nes at our institution. Records were reviewed and analyzed for presentation , metabolic and anatomical anomalies, stone size and location, outcome and complications. Average stone size was 9.5 x 6.5 mm. (range 3 to 32). Stones were in the upper ureter in 17 cases, mid ureter in 2 and lower ureter in 19. All patients underwent ESWL with a Dornier HM3 lithotriptor under gener al anesthesia. Nephrostomies were placed in an anuric infant with bilateral ureteral obstruction and in 2 patients with nonfunctioning kidneys (4 rena l units). Ureteral catheters were used in 15 patients for better identifica tion and localization of the stone during ESWL. The catheters were removed immediately postoperatively. Results: Of the patients 31 (81.5%) were free of stones after 1 session of ESWL, 5 (13.1%) after 2 and 1 after 3. One patient underwent ureteroscopy f or residual fragments after 2 ESWL sessions. The stone-free rate following 1 ESWL session was 100% for ureteral calculi 10 mm. or smaller regardless o f location. Of the 12 patients with stones larger than 10 mm. 8 (67%) were free of stones following 1 ESWL session. The overall success rate of ESWL w as 97.3%. No child had postoperative urinary infection or ureteral obstruct ion. Conclusions: ESWL is an efficient and safe modality for the treatment of pe diatric ureteral stones.