Short-term changes in renal function after extracorporeal shock wave lithotripsy in children.

PURPOSE: To our knowledge despite numerous studies the biological effect of extracorporeal shock wave lithotripsy (ESWL, Dornier Medical Systems, Inc., Marietta, Georgia) on the function of the immature kidney has not yet been evaluated. We determined the short-term effect of ESWL on renal function in children. MATERIALS AND METHODS: In a 5-year period 65 children were treated for 77 kidney stones by ESWL and followed regularly at our department. In 16 children the short-term effect of shock wave energy was studied by measuring blood parameters (sodium, potassium, urea, creatinine and C-reactive protein), urinary electrolytes (sodium, potassium and creatinine), urinary enzyme activity (aspartate transaminase, alanine transferase, alkaline phosphatase and lactate dehydrogenase) and the excretion of beta 2-microglobulin. Samples were obtained immediately before and 2 hours after ESWL, and on days 1, 2, 8, 15, 30 and 90 after treatment. RESULTS: Morphological changes in the kidneys were not detected by ultrasound during followup. No significant changes were noted in overall renal function, serum parameters or urine electrolytes. A significant elevation in the excretion of aspartate transaminase, alkaline phosphatase, lactate dehydrogenase and beta 2-microglobulin was observed, indicating proximal tubular dysfunction and cell destruction. Enzyme levels returned to baseline within 15 days. CONCLUSIONS: Our results demonstrate that shock wave energy induces transient functional damage of tubular function in children. Minimizing the kV. and number of shocks may decrease the deleterious effect. When considering functional regeneration time, the minimal interval between 2 shock wave treatments should be at least 15 days. The long-term effect needs further investigation.

[Extracorporeal shockwave therapy in childhood]. / Húgyúti kövek extracorporalis lökéshullámú kezelése gyermekkorban.

In 27 children aged 4-17 years extracorporeal shock wave lithotripsy (ESWL) was performed for renal and ureteral calculi between January 1 1993 and December 31 1994 at the University Medical School of Pécs. A total of 32 calculi was treated requiring 34 ESWL sessions. All treatments were done with the standard Dornier Compact Mobile Lithotripter device. The mean size of the stones was 10.65 mm and the number of shock waves averaged 2607. No serious intraoperative or postoperative complications were encountered. No auxiliary procedures were performed. The stonefree rate was 27/32 stones (84.4%) 3 months after treatment. 5 patient has residual stone fragments. Lithotripsy using Dornier Compact Mobile device in our series of pediatric patients was found safe and effective.

Vascular anomalies and retroperitoneal lymphadenectomy (RLA).

In the past 7 years a total of 90 RLAs were performed in patients with testicular tumour and the vascular anomaly of the retroperitoneum was diagnosed in 10 cases. Attention is called to these vascular disorders which render the performance of lymph dissection difficult but can never influence the question of operability.

Removal of renal tumours from thoracoabdominal incision.

It is stressed that the 5-year survival in the T3 stage renal tumour patients is decisively influenced by the radical removal of the tumorous kidney. It is, however, often difficult to secure radicality. According to the authors' experience, radicality can be ensured by extrapleural throacoabdominal incision also in the case of large renal tumours. This way of exploration combines the advantages of both the abdominal and high lumbar incisions. It facilitates postoperative care by making thoracic drainage unnecessary.