[Characteristics and efficiency of extracorporeal shock wave lithotripsy in children using ultrasound guidance].

INTRODUCTION: The aim of the study was to retrospectively evaluate the efficiency of extracorporeal shock wave lithotripsy (ESWL) with ultrasound guidance and the results of treatment of children with urolithiasis, of different age groups depending on the stone location and size.

MATERIALS AND METHODS: A total of 135 children and adolescents, aged from 1 to 18 years treated by ESWL at IZMIRLIAN Medical Center from 2005 to 2016 were enrolled in this study. Number, size and location of stones were evaluated. A total of 153 ESWL sessions were performed, including two sessions in 9 cases, three sessions in 1 case, and four sessions in 2 cases. Intra- and posttreatment stone fragmentation rate, number of ESWL sessions, shock-wave pulses per session, stone-free rate, and number of ancillary procedures depending on the stone location and size as well as radiation exposure were evaluated. Follow-up observation was performed after 14, 30 and 90 days.

RESULTS: In most cases, there was a good stone fragmentation after ESWL. From 200 to 3000 low-energy pulses with a frequency 1-2 Hz and power of 30-50 units on Modulith SLK scale were delivered. Number of shock-wave pulses up to 1000, 2000 and 3000 was sufficient in 18.3%, 51.9% and 26.8% cases, respectively. SFR in children aged 1-5 years was 95.2%, compared to 100%, 100% and 83.7% in patients in the 6-10, 11-15 and 16-18 year age groups, respectively. Complete stone clearance was achieved in patients of 1-5 and 6-10 years after two weeks. In only one patient in the 11- to 15-year age group, all fragments passed after two weeks, while in 4 adolescents in the 16- 18-year age group SFR was achieved after more than 3 months. In addition, in other 3 patients in this age group ESWL was unsuccessful.

CONCLUSION: Our results suggest high efficiency of ESWL under ultrasound guidance in children and adolescents. Absence of X-ray exposure, minimal complication rate, non-invasiveness and high efficiency allow to consider ESWL as a method of choice for the treatment of urolithiasis in children and adolescents.