Efficacy of shock wave lithotripsy in management of kidney stones in infants

Abstract

Introduction and objectives: Despite being uncommon, infantile kidney stone remains a major health problem due to its higher recurrence rate and morbidity. The parents usually notice that their infants have recurrent fever and failure to thrive of unknown origin. Those patients comprise a big challenge for the urologist in management. Therefore, this study aimed to evaluate the outcome of shockwave lithotripsy (SWL) in management of renal stones in infants.

Subjects and methods: A retrospective analysis of prospectively collected data performed between January 2009 and December 2012 for infants underwent SWL for single radio-opaque renal stones ≤15 mm at a single stone center. SWL was performed with Dorneir S lithotripter with a maximum of 1500 shocks per session. A single session was indicated for each infant, but a second  session was performed when satisfactory disintegration was not achieved. Follow-up based on urinalysis, urine culture and sensitivity, plain X-ray kidney ureter bladder (KUB) and abdominal ultrasonography (US) was carried out 2 weeks post SWL and monthly for 3 successive months. Multislice Computed tomography (MSCT) was performed 3-months post-SWL to confirm the stone-free status.

Results: A total of 87 infants, less than 24 months of age were enrolled in this research. SWL success was defined as absence of any residual fragments on MSCT 3-months after the last session. Stone free rate was 93.1% after the first SWL session and reached 100% after the second session. Rate of retreatment with second session of SWL was 6.9%. Urinary tract infection (UTI) was detected in 10.3%, transient renal obstruction with low grade fever in 4.6% of infants and no major complication had been recorded.

Conclusion: The new generation of SWL technology with a precise focal area seems to be safe and effective in management of kidney calculi in infants.

Keywords: Shockwave lithotripsy; Urolithiasis; Infants; Kidney