Open Access

ARTICLE

Extracorporeal shockwave lithotripsy in infants

Prem A. Ramakrishnan, Mohammed Medhat, Younis H. Al-Bulushi, Priti Nair, Ahmed Al-Kindy

Departments of Urology, Accident, Emergency and General Surgery, Armed Forces Hospital, Muscat, Sultanate of Oman
Address correspondence to Dr. Prem A. Ramakrishnan, Armed Forces Hospital, PO Box 726, Post Code 111, CPO Seeb, Sultanate of Oman

Canadian Journal of Urology 2007, 14(5), 3684-3691.

Abstract

Introduction: Pediatric urolithiasis is relatively uncommon and limited information is available on the application of minimally invasive management modalities in young children. We present a single centre experience with extracorporeal shockwave lithotripsy (ESWL) for infants with upper urinary tract calculi.
Material and methods: A total of 74 infants aged 3 months to 24 months with upper urinary tract calculi were treated with ESWL under general anesthesia using the Wolf 2500 and the 2501 Piezolith lithotriptors over a 14 and a half-year period. Patient and stone characteristics, risk factors for urolithiasis, treatment parameters, clinical outcomes and long-term follow-up were assessed and recorded.
Results: The mean patient age was 14.5 (range 3 to 24) months. The mean renal stone size was 18.2 (range 7 to 32) mm while the mean ureteral stone size was 9.4 (range 5 to 14) mm. Metabolic abnormalities, structural anomalies and urinary tract infections were identified as contributory factors for stone formation in 34% of the infants. At the 3-month follow-up there was an overall successful outcome in 72 infants (97%) that included 65 (88%) who were rendered stone-free and 7 (9%) who had clinically insignificant stone fragments. Retreatment was required in 27 (35%) patients, auxiliary procedures after ESWL were needed in 5 (7%) and secondary operative procedures were required in 2 (3%). Major complications were encountered in 5 (7%) patients that included complete ureteral obstruction with sepsis in 2, partial ureteral obstruction in 1 and febrile urinary tract infection in 2 other children. Long-term follow-up was recorded in 39 infants: 8 developed recurrent stones, 2 had stone regrowth and 1 developed mild hypertension but none had significant deterioration of renal function.
Conclusions: ESWL is an effective treatment for upper urinary tract calculi in infants. In the short-term, complications are minimal but long term follow up is needed.

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