Landau Ezekiel H, Shenfeld Ofer Z, Pode Dov, Shapiro Amos, Meretyk Shimon, Katz Giora, Katz Ran, Duvdevani Mordechai, Hardak Benjamin, Cipele Helio, Hidas Guy, Yutkin Vladimir, Gofrit Ofer N
Pediatric Urology Unit, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
J Urol. 2009 Oct;182(4 Suppl):1835-9. doi: 10.1016/j.juro.2009.04.084. Epub 2009 Aug 18.
The sophistication of percutaneous nephrolithotomy and ureteroscopy challenges the efficacy of ESWL for urolithiasis in prepubertal patients. We evaluated our long-term experience with ESWL in these patients and determined its efficiency.
We retrospectively reviewed the charts of all prepubertal patients who underwent ESWL. We evaluated the need for tubing, the 3-month stone-free rate, the need for additional ESWL, and the effect of stone size and location, and cystinuria on the 3-month stone-free rate.
Between 1986 and 2008, 119 males and 97 females with a mean age of 6.6 years who had urolithiasis underwent ESWL using the Dornier HM3 lithotriptor. We treated 157 children with renal calculi with an average +/- SD diameter of 14.9 +/- 8.9 mm, of whom 66 (42%) required a tube in the urinary system. The 3-month stone-free rate was 80% and 31 patients (19.7%) needed an additional procedure. Stone location did not affect the stone-free rate but stone size did. We treated 59 patients for ureteral stones with an average stone length of 9.5 +/- 4.8 mm, of whom 41 (69%) required tube insertion. The 3-month stone-free rate was 78% and 13 patients (22%) needed an additional procedure. The 3-month stone-free rate did not depend on stone location or size. The rate was 37.5% in patients with cystinuria and 82.5% in all others (p <0.0001). Six patients (2.8%) had complications.
The 3-month stone-free rate after ESWL in prepubertal patients is 80% and 20% of patients require additional procedures. ESWL is most effective for kidney stones less than 11 mm. ESWL has inferior results for cystine stones compared to other calculi. Complications are rare.
经皮肾镜取石术和输尿管镜检查技术的复杂性对体外冲击波碎石术（ESWL）治疗青春期前患者尿路结石的疗效提出了挑战。我们评估了在这些患者中进行ESWL的长期经验，并确定了其有效性。
我们回顾性分析了所有接受ESWL的青春期前患者的病历。我们评估了置管需求、3个月无石率、额外进行ESWL的需求，以及结石大小、位置和胱氨酸尿症对3个月无石率的影响。
1986年至2008年期间，119例男性和97例女性尿路结石患者接受了使用多尼尔HM3碎石机的ESWL治疗，平均年龄6.6岁。我们治疗了157例肾结石患儿，结石平均直径±标准差为14.9±8.9mm，其中66例（42%）需要在泌尿系统置管。3个月无石率为80%，31例患者（19.7%）需要额外的治疗。结石位置不影响无石率，但结石大小有影响。我们治疗了59例输尿管结石患者，结石平均长度为9.5±4.8mm，其中41例（69%）需要插管。3个月无石率为78%，13例患者（22%）需要额外的治疗。3个月无石率不取决于结石位置或大小。胱氨酸尿症患者的无石率为37.5%，其他所有患者为82.5%（p<0.0001）。6例患者（2.8%）出现并发症。
青春期前患者ESWL治疗后3个月无石率为80%，20%的患者需要额外治疗。ESWL对小于11mm的肾结石最有效。与其他结石相比，ESWL治疗胱氨酸结石的效果较差。并发症罕见。
