Urology Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
J Urol. 2010 Sep;184(3):1111-4. doi: 10.1016/j.juro.2010.05.016. Epub 2010 Jul 21.
The effect of extracorporeal shock wave lithotripsy on the growing kidneys of young children has always been a concern. We determined whether shock wave lithotripsy causes renal parenchymal scarring or affects glomerular filtration rate in children.
This prospective study included 100 children with renal stones who presented to the shock wave lithotripsy unit at our institution between March 2005 and March 2008. A total of 28 children had multiple stones in the same kidney. All children with bilateral renal stones had 1 kidney cleared of stones by percutaneous nephrolithotomy before undergoing shock wave lithotripsy. A total of 138 stones were subjected to shock wave lithotripsy. All children underwent radionuclide scan of the renal parenchyma using dimercapto-succinic acid, and glomerular filtration rate was estimated using diethylenetriamine pentaacetic acid before extracorporeal shock wave lithotripsy and 6 months afterward. Children with renal scarring due to previous surgery or vesicoureteral reflux were excluded from the study. The number of shock wave lithotripsy sessions to achieve stone-free status and the dose of shock waves used were recorded for each patient.
No patient demonstrated renal parenchymal scarring on dimercapto-succinic acid scan or any statistically significant change in glomerular filtration rate on diethylenetriamine pentaacetic acid scan up to 6 months after shock wave lithotripsy.
Shock wave lithotripsy is a safe modality for treating renal calculous disease in children up to 16 years old, with no impact on long-term kidney function.
体外冲击波碎石术对幼儿生长中肾脏的影响一直令人关注。我们旨在确定冲击波碎石术是否会导致小儿肾实质瘢痕形成或影响肾小球滤过率。
本前瞻性研究纳入了 2005 年 3 月至 2008 年 3 月期间在我院碎石中心就诊的 100 例肾结石患儿。共有 28 例患儿同一侧肾脏存在多发结石。所有双侧肾结石患儿均先行经皮肾镜碎石术清除 1 侧肾结石，再行冲击波碎石术。共对 138 个结石行冲击波碎石术。所有患儿碎石前及碎石后 6 个月均行二巯丁二酸肾动态显像，并使用二乙三胺五乙酸估算肾小球滤过率。排除因既往手术或膀胱输尿管反流导致肾瘢痕形成的患儿。记录每位患儿达到结石清除状态所需的冲击波碎石术次数和使用的冲击波剂量。
碎石后 6 个月内，所有患儿二巯丁二酸扫描均未见肾实质瘢痕形成，二乙三胺五乙酸扫描肾小球滤过率也无统计学意义的变化。
对于 16 岁以下的肾结石患儿，冲击波碎石术是一种安全的治疗方法，对长期肾功能无影响。
