Pediatric Urology Department, Assiut University Hospital, Assiut University, Assiut, Egypt.
Pediatric Nephrology Department, Assiut University Hospital, Assiut University, Assiut, Egypt.
J Urol. 2014 May;191(5 Suppl):1491-5. doi: 10.1016/j.juro.2013.10.060. Epub 2014 Mar 26.
We prospectively evaluated the efficacy of dissolution therapy and standard shock wave lithotripsy as a noninvasive modality for radiolucent renal stones in children.
A total of 87 children with radiolucent renal calculi were included in study. Median age was 2.5 years (range 0.5 to 13). Computerized tomography was done to confirm a stone density of less than 500 HU. Median stone length was 12 mm (range 7 to 24). Patients were randomly divided into 2 groups. The medical group of 48 patients received potassium sodium hydrogen citrate at a dose of 1 mEq/kg per day for 1 to 3 months. The shock wave lithotripsy group of 39 patients were treated with a Lithotripter S (Dornier Medtech, Kennesaw, Georgia) while under general anesthesia. Complications in each group were recorded. Patients were considered stone free when imaging within 3 months showed no evidence of stones.
The stone-free rate was 72.9% for dissolution therapy vs 82.1% after a single session of shock wave lithotripsy (p = 0.314). One patient per group experienced a pyelonephritis episode during followup (p = 0.698). Three of the 13 patients in whom medical regimens failed were noncompliant and 5 ingested the medication sporadically.
Medical dissolution therapy is a well tolerated, effective treatment for radiolucent renal stones in children. It eliminates the need for shock wave lithotripsy in up to 73% of cases.
我们前瞻性地评估了溶解疗法和标准体外冲击波碎石术作为一种非侵入性方法治疗儿童透光性肾结石的疗效。
共有 87 名患有透光性肾结石的儿童纳入研究。中位年龄为 2.5 岁（范围 0.5 至 13 岁）。进行计算机断层扫描以确认结石密度低于 500HU。中位结石长度为 12mm（范围 7 至 24mm）。患者随机分为 2 组。48 名接受枸橼酸钾钠氢治疗的药物组患者每天接受 1mEq/kg 的剂量治疗 1 至 3 个月。39 名接受体外冲击波碎石术治疗的冲击波碎石术组患者在全身麻醉下接受治疗。记录每组的并发症。当 3 个月内的影像学检查显示无结石证据时，患者被认为是结石清除的。
溶解治疗的结石清除率为 72.9%，单次体外冲击波碎石术为 82.1%（p=0.314）。每组有 1 名患者在随访期间发生肾盂肾炎（p=0.698）。药物治疗失败的 13 名患者中有 3 名不遵守规定，5 名患者偶尔服用药物。
药物溶解治疗是一种耐受良好、有效的儿童透光性肾结石治疗方法。它可在多达 73%的病例中消除体外冲击波碎石术的需要。
