Shock wave lithotripsy for renal stone in children

Interventional management of urolithiasis in children has evolved dramatically over the past 3 decades. Open surgery with its antecedent risks on need for re-treatment has almost completely been replaced by endourological treatment in most centers in the West. The higher incidence of pediatric urolithiasis in the developing world with lack of well-equipped endourological centers still mandates use of knife for stones. Since its initial reports in the mid-1980s, shock wave lithotripsy (SWL) has become the current standard therapeutic alternative for most of the moderate-sized renal stones. The intrinsic ability of pediatric ureter to transmit relatively large stone fragments encouraged investigators to treat even larger stones as well as staghorn stones with SWL monotherapy in a safe and efficacious manner. Long-term safety of shock wave application on the growing kidneys was a major concern in using SWL in particularly younger children. Although there is lack of quality data on this subject, many contemporary studies have shown long-term safety of SWL even for very young children. Among the major short-term complications, development of obstructive Steinstrasse and urosepsis are two major concerns. Fortunately the overall incidence of major complications is quite low. In essence, SWL for pediatric renal stone is safe and highly efficacious, and there is lack of evidence that it is associated with any significant long-term consequences. The use of stent is often unnecessary, and relatively larger stones could be treated by SWL compared to adults.