ABSTRACT
Purpose: To evaluate the outcome of ESWL in paediatric group of patients
Patients and Methods: 70 children with 86 urinary calculi [79 stones in 66 renal units and 7 bladder stones] were treated by ESWL under general anaesthesia in 61 and sedo-analgesia in 9. The ages of patients ranged from 2 to 15.5 years [mean 12.9]. Of the 70 patients, 50 [71.4%] presented with pain and 11[15.7%] with haematuria. Stone size ranged from 5 to 30 mm; with an average of 11.4 mm. Stones were unilateral in 60 cases, bilateral in 3 patients and in the bladder in 7 cases. Except for 6 calculi sized 2-3 cm, all the stones measured <2 cm. Fifty-eight cases had single stone, 8 had 2 stones and 4 had multiple stones and most of the stones had poor density on plain X-ray films. Routine follow-up included renal ultrasound, blood pressure controls, laboratory tests and eventually plain X-ray film
Results: ESWL resulted in stone fragmentation in 71/79 stones in reno-ureteral units [89.9%] and 7/7[100%] in bladder stone. Fragmentation occurred after one session in 52 stones, after two sessions in 16 stones, and after multiple shock wave sessions in 10 stones. Auxiliary procedures were required in 15 children [21.4%]. After 3 months, 42 [63.6%] out of 66 reno-ureteral units were stone free. Non-surgical residual fragments [<4 mm] were present in 11 units [16.7%]. The procedure failed in 8 renal units [12.1 %], viz.3 in lower calyx, 2 in middle ureter, 1 in pelvis, 1 in middle calyx, and l in upper ureter. After 6 months follow-up, 51 [77 .2 %] out of 66 reno-ureteral units were stone-free and 6 units [9.1 %] had non-surgical residual fragments. The overall success rate for stone-free patients was 91.4% [64/70] after 6 months. The success rate for ESWL in stones located in reno-ureteral units was 86.4% [57/66]. Twenty children were lost to follow-up after 6 months
Conclusion: ESWL is an effective and the most suitable technique for the treatment of the paediatric calculi with low significant morbidity