درمان سنگ های کلیوی کودکان با استفاده از سنگ شکنی برون اندامی (ESWL)

Background and purpose : Çhildren with urinary stone disease for longer period of time are at risk of stone recurrence. Ïn two-thirds of the cases medical intervention is mandatory and minimally invasive therapy is advised. The purpose of this research was the evaluate the efficacy and complications of ËSWL in these children. Materials and methods : Ïn this study 30 patients with renal stones were recruited. Patients with ureteral and bladder stones were excluded. Ïmaging study for diagnosis of renal stons were sonography (23 patients) kidney-ureter-bladder (3 patients) and intravenous pyelography (ÏVP) (4 patients). Âll patients were evaluated for PT, PTT and medical history of coagulophaty. 25 patients had renal stones lesser than 20 mm and 5 patients had stones greater than 20mm. Patients treated with 1200- 2200 shocks (mean1500) and 16-18 KV. Âll patients were evaluated with sonography 2 weeks, 4 weeks and 12 weeks after treatment. Ïn patients with renal stones greater than 2cm a double J stent inserted before ËSWL. Results : Stones were from 9 to 26 mm in size. (mean 13 mm). 25 patients became stone free (83.3%) after on course of ËSWL. Ïn one patient (3.3%) three courses and in 4 patients (13.3%) 2 courses of ËSWL necessitated for removing of stones. Two cases (6.6%) complicated with steinstrasse one of whome was managed with conservative therapy and in the other TÜL was done. Çonclusion : Ëxtracorporeal shock wave lithotripsy is effective in the treatment of renal stones in children. Ïn patients with stones greater than 2 cm additional course of ËSWL may be necessary. We recommend that in patients with stones greater than 2 cm insertion of a double J stent can reduce occurrence of steinstrasse. Çomplication of ËSWL in children is very low and no significant morbidity occurs with ËSWL.