Monotherapy extracorporeal shock wave lithotripsy for the treatment of staghorn calculi in children

Purpose: We evaluate the efficacy and parenchymal consequences of extracorp oreal shock wave lithotripsy (ESWL*) for staghorn calculi in children. Materials and Methods: From 1991 to 1999, 16 young patients 5.5 months to 2 years old and 7 older children 6 to 11 years old were treated for complete (6) or partial (17) staghorn calculi. Infection was the main factor of lit hogenesis, particularly in younger children. In 21 patients the stone burde n was more than 20 mm. All patients were treated under general anesthesia u sing a 14 kV. Sonolith 3000 dagger (14) or a 12 to 20 kV. Nova double dagge r (9) lithotriptor. In 5 of the 7 older children a Double 58 stent was inse rted before treatment. In the younger children group calculi were fragmente d after 1 (11) or 2 (5) sessions. Of the 7 older children 3 required 3 (1) and 4 (2) treatment sessions. To assess the long-term effect of ESWL on the parenchyma, dimercaptosuccinic acid renal scan was performed the day befor e and 6 months after therapy in 20 patients. Results: Of the 16 younger children 14 became stone-free (87.5%) and 2 had small asymptomatic residual fragments, Of the 7 older children 5 were stone -free (71.4%) and 2 required additional surgery. No steinstrasse or pyelone phritis occurred after ESWL and no parenchymal or ureteral lesion related t o ESWL was identified on conventional dimercapto-succinic acid scintigraphy . At a followup of 9 months to 9 years all patients have normal blood press ure. Conclusions: ESWL as a first option is safe and appropriate for the treatme nt of staghorn calculi in children particularly in younger children with in fected calculi.