Paediatric ureteric calculi: Efficacy of primary in situ extracorporeal shock wave lithotripsy

Abstract

Objective. To evaluate the efficacy of primary in situ extracorporeal shockwave lithotripsy (ESWL) for the treatment of ureteric calculi in children. Patients and methods. The Wolf 2500 Piezolith was used to treat 63 children (aged 4 months to 12 years) with 76 ureteric calculi, including 10 children with impacted calculi. The calculi were located in 14 upper, 13 mid and 44 lower ureters, and the stone burden varied from 4 to 17.8 mm (mean 12.6). All children aged ≤ 10 years were treated under general anaesthesia; lithotripsy was attempted under intravenous sedation in the older children. Results. At the 3-month follow-up, there was an overall successful outcome in 55 children (87%), which included 12 of 13, eight of nine (89%) and 35 of 41 (85%) of the children with upper, mid and lower ureteric calculi, respectively, and nine of the 10 with impacted calculi. Re-treatment was required in 20 (36%) patients, while auxiliary procedures after ESWL were required in three (6%). The major complications encountered were ureteric obstruction with sepsis in two children, bacteraemia in another and urinary retention due to a urethral stone fragment in a fourth child. Conclusions. In situ ESWL was an effective treatment modality for ureteric calculi at all levels in children, even when impacted. In the short term, complications were minimal, but the long-term effects need further assessment.