We determined whether stone attenuation can predict stone fragmentation after shock wave lithotripsy in the pediatric population. Previous studies show that preoperative attenuation in HU on noncontrast computerized tomography predicts shock wave lithotripsy success. To our knowledge study of this parameter in the pediatric population has been lacking to date.
We performed a multi-institutional review of the records of 53 pediatric patients 1 to 18 years old who underwent shock wave lithotripsy for 3.8 to 36.0 mm renal calculi. Stone size, average skin-to-stone distance and attenuation value were determined by bone windows on preoperative noncontrast computerized tomography. Success was defined as radiographically stone-free status at 2 to 12-week followup after a single lithotripsy session without the need for further sessions or ancillary procedures.
After lithotripsy 33 patients (62%) were stone-free and 20 had incomplete fragmentation or required additional procedures. Mean ± SD stone attenuation in successfully treated patients vs those with incomplete fragmentation was 710 ± 294 vs 994 ± 379 HU (p = 0.007). Logistical regression analysis revealed that only attenuation in HU was a significant predictor of success. When patients were stratified into 2 groups (less than 1,000 and 1,000 HU or greater), the shock wave lithotripsy success rate was 77% and 33%, respectively (p <0.003).
Stone attenuation less than 1,000 HU is a significant predictor of shock wave lithotripsy success in the pediatric population. This finding suggests that attenuation values have a similar predictive value in the pediatric population as that previously reported in the adult population.
[Show abstract][Hide abstract] ABSTRACT: Succes van behandeling met Extracorporeal Shock Wave Lithotripsy (ESWL) bij patiënten met urolithiasis is lastig te voorspellen. De literatuur beschrijft een verband tussen steendensiteit op non-contrast Computed Tomography (NCCT) en het succes van behandeling met ESWL. In deze studie werden gedurende 24 maanden alle patiënten met urolithiasis, die voor behandeling met ESWL een NCCT ondergingen, geëvalueerd.
Steendensiteit op een NCCT lijkt een goed hulpmiddel bij het voorspellen van succes van behandeling met ESWL.
[Show abstract][Hide abstract] ABSTRACT: Over the past 3 decades, minimally invasive stone surgery has completely overtaken open surgical approaches to upper tract pediatric urolithiasis. Progressing from least to most minimally invasive, extracorporeal shock wave lithotripsy, ureteroscopy, and percutaneous nephrolithotomy are the surgical methods of today for kidney and ureteral stones. The choice of treatment modality is individualized in children, considering patient age, stone size, number, location, and anatomic and clinical contributing factors. The purpose of this article is to review these techniques for pediatric upper urinary tract stones and summarize outcomes and complications.
Pediatric Clinics of North America 08/2012; 59(4):897-908. DOI:10.1016/j.pcl.2012.05.019 · 2.12 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objective:
To define the preoperative kidney and stones characteristics on noncontrast-enhanced computed tomography that affect the success of extracorporeal shockwave lithotripsy (SWL) for treatment of renal calculi in pediatric patients.
Materials and methods:
From 2005 to 2011, 57 children (age <16 years) with documented preoperative noncontrast-enhanced computed tomography scans underwent SWL for treatment of renal stones and were included in the present study. Stone size, site, multiplicity, average skin-to-stone distance, stone attenuation value, and kidney morphology were determined from the preoperative noncontrast-enhanced computed tomography scans. Success was defined as radiographically stone-free status at the 3-month follow-up examination after a single lithotripsy session without the need for additional sessions or ancillary procedures.
After a single session of SWL, 24 children (42.1%) were stone free on the 3-month follow-up imaging study without the need for additional SWL sessions. Treatment failed in 33 patients (57.9), with residual fragments in 30 children, of whom 29 required repeat SWL, and 3 with stones that were considered unchanged and were finally treated with percutaneous nephrolithotomy. Logistic regression analysis revealed that stone attenuation in Hounsfield units (HU) and stone length were the only significant predictors of success. When the HU were stratified into 2 groups of ≤600 and >600 HU, the SWL success rate was 82.1% and 20%, respectively (P = .023). When length was stratified as ≤12 mm and >12 mm, the stone-free rate was 58.6% and 25.1%, respectively (P = .016).
Stone attenuation ≤600 HU and stone length ≤12 mm were significant independent predictors of SWL success in children.
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