Langzeitverlauf nach ESWL bei Kindern: Steinfreiheit, Rezidivsteinrate, Blutdruck und Nierenfunktion

Since 1984, 105 ESWL treatments of 65 renoureteral units have been performed in 56 children (30 boys and 26 girls, age range: 1.5-16 years, mean age: 8.8 years) using the Dornier HM 3 and Storz modulith lithotripters. This accounts for about 1% of the ESWL treatments (10 676) performed during this time period. Associated metabolic disorders had been present in 11/56 children (20%), anatomical anomalies in 11/56 children (20%) and 34/56 patients (61%) had had recurrent urinary tract infection. A total of 29 children (52%) had been stone-free at the time of discharge from the hospital and 84% three months after ESWL. The follow-up period ranged from 9 months to 8 years (mean follow-up: 3.8 years). At the time of evaluation, history was taken and blood pressures, serum creatinine, urine culture, KUB, renal ultrasound and/or IVP and MAG 3 or I-123-Hippuran isotope renograms were obtained. During the follow-up period, stones had recurred in 8% of the children who had become stone-free after ESWL. In all of the 9 patients (23%), who had not become stone free, regrowth of residual fragments had occurred, 12 children had been subjected to repeated hospital admissions for stone treatment during the follow-up period: 7 children had been treated by repeated ESWL because of residual fragments and stone regrowth (5) or true stone recurrence (2). Percutaneous litholapaxy had been performed in one girl with cystinuria and staghorn stones. In 4 children with initial staghorn calculi and previous stone surgery (2 cases), 4 partial nephrectomies had been performed because of residual stones. One nephrectomy had been performed in a girl with cystinuria, who did not comply to stone metaphylaxis. Blood pressures had been normal at the time of ESWL in all children and remained within their age-specific 5th and 95th percentiles during the follow-up period after ESWL. Total and split renal function remained within their age-specific normal ranges. The only exception was the girl with an obstructing recurrent cystine stone in the ESWL-treated kidney, who required nephrectomy because of complete loss of function.