Thursday, January 3, 2013

No Long-Term Harm Seen From Pediatric Shockwave Lithotripsy


NEW YORK (Reuters Health) Sep 17 - The efficacy of extracorporeal shockwave lithotripsy (SWL) in treatment of renal calculi in children is well established, and new research suggests there are no long-term harms from the intervention.
"These findings encourage the treatment of renal calculi in children using SWL technology without fear of development of systemic diseases (such) as diabetes and hypertension," Dr. Ahmed R. EL-Nahas told Reuters Health by email.
In a paper online August 23 in BJU International, Dr. El-Nahas and colleagues at Mansoura University in Egypt note that animal models have shown histological changes in renal tubular and glomerular epithelium and interstitial cells following high energy shockwave exposure. There also have been some reports of alterations of growth rate in pediatric kidneys.
To investigate further, the researchers retrospectively reviewed data on 70 children who underwent shockwave lithotripsy monotherapy from 1990 through 2009. They were followed for at least two years (mean 3.6 years) and their mean age at last follow-up was 11.6 years.
The treated kidney was examined by ultrasonography for measurement of renal length and detection of stones. The measured lengths were then compared with age-calculated normal renal lengths in healthy children.
Only one child had a kidney smaller than one standard deviation of the calculated length. This patient, a girl, had required three lithotripsy sessions to become stone-free. The current problem was brought about by a stone in the pelvic ureter some three years after SWL. She underwent ureteroscopic extraction.
The measured renal lengths of the eight patients aged more than 18 years at follow-up were within normal values for healthy adults.
Estimated blood sugar levels were normal in all children and no patients developed hypertension or diabetes.
The researchers caution that preoperative selective renal function was not estimated and stone analysis and metabolic evaluation were not performed for all patients. In addition, patients who underwent invasive treatment during follow-up were excluded.
Nevertheless, said Dr. EL-Nahas, "This study proved the safety of SWL for treatment of renal calculi in children."
BJU Int 2012.

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