Is the Success of Shock Wave Lithotripsy Different in Preschool and School Age Children?

Öz

Objective: The aim of this study was to retrospectively compare the efficacy and safety of shock wave lithotripsy (SWL) in preschool (0-7 years) and school age (8-16) period.

Material and Methods: The data of 283 pediatric patients under the age of 16 years who were treated with SWL between January 2014 and January 2018 were analyzed retrospectively. The patients were divided into two groups as preschool (Group 1, <7 years) and school age (Group 2, 7-16 years). The diagnosis was made by direct urinary tract X-ray, ultrasonography, intravenous urography and/or reduced-dose non-contrast computed tomography. The groups were evaluated in terms of success, focusing method, stone localization, size, opacity and complications.

Results: Of the 283 pediatric patients, 166 (58.6%) were male and 117 (41.4%) were female. SWL success rates were 127/132 (96.2%) in group 1 and 136/151 (90.1%) in group 2. In 108 patients (81.8%) and 93 (61.6%) patients in group 2, stone sizes were less than 10 mm. The ratio of opaque / non-opaque stones in groups 1 and 2 was respectively 54 (40.9%) / 78 (59.1%) and 104 (68.9%) / 47 (31.1%). Complications were observed in 5 patients (3.8%) of group 1 and 6 (4%) patients in group 2.

Conclusion: Although there are many alternative methods of treatment for stone disease in childhood, SWL is still used as a first-line treatment option in appropriate cases currently. In the preschool period, the passage and clearance of the broken stone fragments is easier than in the school age period and increases the success of SWL. In the treatment of urinary tract stone disease in preschool children, SWL is more successful than school-age children. This will be better elucidated by larger randomized prospective patient series.

Anahtar Kelimeler

• Shock wave,lithotripsy,pediatric,stone disease

OKUL ÖNCESİ VE OKUL ÇAĞI ÇOCUKLARDA ŞOK DALGA LİTOTRİPSİ BAŞARISI FARKLI MI?

Öz

Amaç: Bu çalışmamızdaki amaç, okul öncesi (0-7 yaş) ve okul çağı (8-16) dönemindeki böbrek taşı tedavisinde şok dalga litotripsi (SWL) etkinliğinin ve güvenilirliğinin retrospektif olarak karşılaştırılmasıdır.

Gereç ve Yöntemler: Ocak 2014 - Ocak 2018 tarihleri arasında böbrek taşı olan ve SWL ile tedavi edilen 16 yaşından küçük toplam 283 çocuk hastanın verileri retrospektif olarak incelendi. Hastalar okul öncesi (Grup 1, <7 yaş) ve okul çağı (Grup 2, 7-16 yaş) olmak üzere iki gruba ayrıldı. Tanı, direkt üriner sistem grafisi, ultrasonografi, intravenöz ürografi ve/veya azaltılmış doz kontrastsız bilgisayarlı tomografi ile konuldu. Gruplar; başarı, odaklama yöntemi, taş lokalizasyonu, boyut, opasite ve komplikasyonlar açısından değerlendirildi.

Bulgular: İki yüz seksen üç çocuk hastanın 166 (%58.6)’sı erkek 117 (%41.4)’si ise kız idi. SWL başarı oranları grup 1’de 127/132 (%96.2) ve grup 2’ de 136/151 (%90.1) olarak belirlendi. Grup 1’de 108 (%81.8) ve grup 2’de 93 (%61.6) hastada taş boyutlarının ≤ 10 mm olduğu belirlendi. Sırasıyla 1. ve 2. gruplarda opak / non-opak taş oranı; 54 (%40.9) / 78 (%59.1) ve 104 (%68.9) / 47 (%31.1) idi. Grup 1’de 5 (%3.8), grup 2’de ise 6 (%4) hastada komplikasyon izlendi.

Sonuç: Çocukluk çağında görülen taş hastalığında tedavi için birçok alternatif tedavi yöntemi olmasına rağmen, SWL hala güncelliğini korumakta ve uygun olgularda hala ilk basamak tedavi seçeneği olarak kullanılmaktadır. Okul çağı dönemine göre okul öncesi dönemde, kırılan taş fragmanlarının pasajı ve temizlenmesi daha kolaydır ve SWL başarısını arttırmaktadır. Okul öncesi çocuklardaki üriner sistem taş hastalığının tedavisinde SWL, okul çağındaki çocuklardan daha başarılıdır. Randomize prospektif daha büyük hasta serileri ile bu durum daha iyi aydınlatılabilecektir.

Anahtar Kelimeler

• şok dalga,litotripsi,pediatrik,taş hastalığı

Kaynakça

1. 1. Cohen TD, Ehreth J, King LR, Preminger GM. Pediatric urolithiasis: medical and surgical management. Urology. 1996;47(3):292-303.
2. 2. Sen H, Seckiner I, Bayrak O, Erturhan S, Demirbag A. Treatment alternatives for urinary system stone disease in preschool aged children: results of 616 cases. J Pediat Urol. 2015;11(1):34.e1-5.
3. 3. Remzi D, Cakmak F, Erkan I. A study on the urolithiasis incidence in Turkish school-age children. J Urol. 1980;123(4):608.
4. 4. Turney BW, Reynard JM, Noble JG, Keoghane SR. Trends in urological stone disease. BJU International. 2012;109(7):1082-7.
5. 5. Gearhart JP, Herzberg GZ, Jeffs RD. Childhood urolithiasis: experiences and advances. Pediatrics. 1991;87(4):445-50.
6. 6. Coward RJ, Peters CJ, Duffy PG, Corry D, Kellett MJ, Choong S et al. Epidemiology of paediatric renal stone disease in the UK. Arch Dis Child. 2003;88(11):962-5.
7. 7. Dede O, Sancaktutar AA, Dagguli M, Utangac M, Bas O, Penbegul N. Ultra-mini-percutaneous nephrolithotomy in pediatric nephrolithiasis: both low pressure and high efficiency. J Pediat Urol. 2015;11(5):253.e1-6.
8. 8. Assimos D, Krambeck A, Miller NL, Monga M, Murad MH, Nelson CP et al. Surgical Management of Stones: American Urological Association/Endourological Society Guideline, PART II. J Urol. 2016;196(4):1161-9.

9. 9. Myers DA, Mobley TB, Jenkins JM, Grine WB, Jordan WR. Pediatric low energy lithotripsy with the Lithostar. J Urol. 1995;153(2):453-7.
10. 10. Elsobky E, Sheir KZ, Madbouly K, Mokhtar AA. Extracorporeal shock wave lithotripsy in children: experience using two second-generation lithotripters. BJU International. 2000;86(7):851-6.
11. 11. Muslumanoglu AY, Tefekli A, Sarilar O, Binbay M, Altunrende F, Ozkuvanci U. Extracorporeal shock wave lithotripsy as first line treatment alternative for urinary tract stones in children: a large scale retrospective analysis. J Urol. 2003;170(6 Pt 1):2405-8.
12. 12. Rizvi SA, Naqvi SA, Hussain Z, Hashmi A, Hussain M, Zafar MN et al. Management of pediatric urolithiasis in Pakistan: experience with 1,440 children. J Urol. 2003;169(2):634-7.
13. 13. Aksoy Y, Ozbey I, Atmaca AF, Polat O. Extracorporeal shock wave lithotripsy in children: experience using a mpl-9000 lithotriptor. World J Urol. 2004;22(2):115-9.
14. 14. Raza A, Turna B, Smith G, Moussa S, Tolley DA. Pediatric urolithiasis: 15 years of local experience with minimally invasive endourological management of pediatric calculi. J Urol. 2005;174(2):682-5.
15. 15. Newman DM, Coury T, Lingeman JE, Mertz JH, Mosbaugh PG, Steele RE et al. Extracorporeal shock wave lithotripsy experience in children. J Urol.1986;136(1 Pt 2):238-40.
16. 16. Carvajal Busslinger MI, Gygi C, Ackermann D, Kaiser G, Bianchetti M. Urolithiasis in childhood: when to do what? Eur J Pediatr Surg. 1994;4(4):199-200.
17. 17. Mahmud M, Zaidi Z. Percutaneous nephrolithotomy in children before school age: experience of a Pakistani centre. BJU International. 2004;94(9):1352-4.
18. 18. Unsal A, Resorlu B, Kara C, Bozkurt OF, Ozyuvali E. Safety and efficacy of percutaneous nephrolithotomy in infants, preschool age, and older children with different sizes of instruments. Urology. 2010;76(1):247-52.
19. 19. Thomas R, Frentz JM, Harmon E, Frentz GD. Effect of extracorporeal shock wave lithotripsy on renal function and body height in pediatric patients. J Urol.1992;148(3 Pt 2):1064-6.
20. 20. Demirkesen O, Onal B, Tansu N, Altintas R, Yalcin V, Oner A. Efficacy of extracorporeal shock wave lithotripsy for isolated lower caliceal stones in children compared with stones in other renal locations. Urology. 2006;67(1):170-4; discussion 4-5.
21. 21. Esen T, Krautschick A, Alken P. Treatment update on pediatric urolithiasis. World J Urol. 1997;15(3):195-202.
22. 22. McCullough DL, Yeaman LD, Bo WJ, Assimos DG, Kroovand RL, Griffin AS et al. Effects of shock waves on the rat ovary. J Urol. 1989;141(3):666-9.
23. 23. Van Arsdalen KN, Kurzweil S, Smith J, Levin RM. Effect of lithotripsy on immature rabbit bone and kidney development. J Urol.1991;146(1):213-6.
24. 24. VanDervoort K, Wiesen J, Frank R, Vento S, Crosby V, Chandra M, et al. Urolithiasis in pediatric patients: a single center study of incidence, clinical presentation and outcome. J Urol.2007;177(6):2300-5.
25. 25. Stamatelou KK, Francis ME, Jones CA, Nyberg LM, Curhan GC. Time trends in reported prevalence of kidney stones in the United States: 1976-1994. Kidney International. 2003;63(5):1817-23.
26. 26. Lieske JC, Rule AD, Krambeck AE, Williams JC, Bergstralh EJ, Mehta RA et al. Stone composition as a function of age and sex. CJASN. 2014;9(12):2141-6.
27. 27. Ordon M, Urbach D, Mamdani M, Saskin R, Honey RJ, Pace KT. A population based study of the changing demographics of patients undergoing definitive treatment for kidney stone disease. J Urol. 2015;193(3):869-74.
28. 28. Smaldone MC, Docimo SG, Ost MC. Contemporary surgical management of pediatric urolithiasis. Urol Clin North Am. 2010;37(2):253-67.
29. 29. Dogan HS, Altan M, Citamak B, Bozaci AC, Karabulut E, Tekgul S. A new nomogram for prediction of outcome of pediatric shock-wave lithotripsy. J Pediatr Urol. 2015;11(2):84.e1-6.
30. 30. Bohris C, Bayer T, Lechner C. Hit/Miss monitoring of ESWL by spectral doppler ultrasound. Ultrasound Med Biol. 2003;29(5):705-12.
31. 31. Van Besien J, Uvin P, Hermie I, Tailly T, Merckx L. Ultrasonography ıs not ınferior to fluoroscopy to guide extracorporeal shock waves during treatment of renal and upper ureteric calculi: A randomized prospective study. Biomed Res Inter. 2017;2017:1-7.
32. 32. Goel H, Gahlawat S, Bera MK, Pal DK, Aggarwal O. Role of clinical and radiological parameters in predicting the outcome of shockwave lithotripsy for ureteric stones. Urol Ann. 2018;10(2):159-64.
33. 33. Tan MO, Kirac M, Onaran M, Karaoglan U, Deniz N, Bozkirli I. Factors affecting the success rate of extracorporeal shock wave lithotripsy for renal calculi in children. Urol Res. 2006;34(3):215-21.