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J Urol. 2014 May;191(5 Suppl):1491-5. doi: 10.1016/j.juro.2013.10.060. Epub 2014 Mar 26.

Dissolution therapy versus shock wave lithotripsy for radiolucent renal stones in children: a prospective study.

Author information

  • 1Pediatric Urology Department, Assiut University Hospital, Assiut University, Assiut, Egypt.
  • 2Pediatric Nephrology Department, Assiut University Hospital, Assiut University, Assiut, Egypt.
  • 3Radiology Department, Assiut University Hospital, Assiut University, Assiut, Egypt.

Abstract

PURPOSE:

We prospectively evaluated the efficacy of dissolution therapy and standard shock wave lithotripsy as a noninvasive modality for radiolucent renal stones in children.

MATERIALS AND METHODS:

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.

RESULTS:

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.

CONCLUSIONS:

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.

Copyright © 2014 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

KEYWORDS:

kidney; lithotripsy; nephrolithiasis; outcome assessment; potassium citrate

PMID:
24679880
[PubMed - indexed for MEDLINE]
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