Monday, June 10, 2013

ESWL FOR LARGE PELVIC CALCULUS IN A CHILD

 The advent of extracorporeal shock wave lithotripsy (ESWL) as a non-invasive technique has revolutionalised the management of urinary tract calculi.  It is considered a safe and effective treatment for urinary lithiasis in adults.  However, the application of this modality of treatment in children followed rather slowly.   
ESWL over the time has been  found to be a safe and effective primary treatment modality for renal and ureteric stones in children. It had a high success rate and minimal short-term complications. Large staghorn calculi required multiple shock wave sessions and exposed the ‘young’ kidneys( still to be mature) is a concern. 
Even in big calculi it has been noticed that the  child's ureter is capable of transporting the fragments after lithotripsy. Interventional procedures should be a last resort. Expectant management is usually adequate even in patients who develop steinstrasse after ESWL. 
The other visceral organs like lungs should be protected by the polystyrene shields , the positioning in smaller children is challenging and needs expert and delicate  handling.The children are usually administered general anesthesia.
We have been doing routinely ESWL in smaller children with high successful outcome and fortunately did not need any auxiliary procedures.Febrile complications were minimal and treated conservatively.We routinely chose the stones less than 2 cm in paediatric age group.
The case shown above was 4 year old girl with 2 cm calculus in pelvis.The child was taken up for stenting and ESWL under general anesthesia The stone fragmented was carried out under USG guidance with shock wave intensity of 2 ( Dornier Lithotripsy).A total 2000 shocks were delivered with foam shields protecting the lungs of the child.The stone fragmentation was satisfactory .The child was given prophylactically antibiotics and the procedure was uneventful.
The child was discharged after 24 hours.                                               

2 comments:

  1. Nice post.. thanks for sharing this informative blog where lot of information about lithotripsy and it is safe for every age groups people.

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