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

Yıl 2019, Cilt: 21 Sayı: 3, 369 - 376, 31.12.2019

Fatih Özkaya

https://doi.org/10.24938/kutfd.575456

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

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