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Extracorporeal Shock Wave Therapy for Children
Calculi 712
713
EXPERIENCE WITH EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY IN THE PEDIATRIC AGE GROUP. ,>Janet E. Smith, Howard Pollack, Philadelphia, PA; (Presentation by *Janet E. Smith) Since June 1985, 12 pediatric patients (13 kidney/
EXTRACORPOREAL SHOCK WAVE LI THOTR I PS Y FOR CAL CUL I IN HORSESHOE KIDNEYS. *Janet E. Smith, Howard Pollack, Keith N. Van Arsdalen, Philadelphia, PA; (Presentation by *Janet E. Smith) One out of 400 people (0.25%) have a horseshoe
ureters) have been treated with extracorporeal shock wave
lithotripsy (ESWL) at the Hospital of the University of Pennsylvania.
The average age was 11.7 years with an av-
kidney. The incidence of renal calculi is 20% making the overall number of these patients not insignificant.
erage weight and height of 35.5kg and 125 cm, respectively. The smallest chi Id treated was a 15 kg, 95 cm, 3 year old male. Procedures performed prior to ESWL included insertion of a ureteral catheter (3) and percutaneous nephrostomy placement (1). The average number of shock
Extracorporeal shock wave lithotripsy (ESWL) has dramatically changed the management of urol ithiasis but controversy exists regarding the feasibility of treating these patients with this modality due to anatomic and functional
waves given was 1,500 delivered at an average voltage of
these kidneys may make the distance between the flank and the kidney too great to get the calculus into the focal point (F 2). Calculi in medial calyces may also be obscured by the spine in the obi ique position making localization more difficult. Lastly, the outflow may not be dependent thereby impairing the spontaneous passage of the fragments. Over the last 18 months, 14 patients with a horseshoe kidney have presented to the Hospital of the
17 kv. Only one chi Id (7%) required additional procedures and retreatment after the initial ESWL. The only complication was a child with a pelvic kidney who had an episode of blood in her stool 2 days after ESWL. This spontaneously resolved. Of 8 children who have had their 3 month fol low up, 8 (100%) were free of residual fragments.
In conclusion, pediatric patients with calculi
considerations.
The more anterior anatomic position of
can be successfully treated with ESWL with minor mech-
University of Pennsylvania for evaluation and treatment.
anical modifications, minimal complications, and an acceptable rate of adjunctive procedures but care must be taken in patient selection.
Twelve of these patients (86%) were able to have their calculi treated with ESWL. The largest patient weighed 255 pounds. Three of 12 patients (25%) required a second treatment. The pitfalls involved in management as wel I as t.be- use of 11 dry runs 11 pre-operatively, modifications of the gantry, and the use of retrograde catheters in overcoming these problems are discussed. In conclusion, most patients with calculi in a horseshoe kidney can be man-
aged with ESWL primarily with minimal technical modifications.
714
715
EFFECTS OF EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY ON BACTERIAL ADHERENCE IN RABBIT URINARY BLADDERS. Keith N. Van Arsdalen, *Ashok K. Batra, Philadelphia, PA; (Presentation by Keith N. Van Arsdalen)
EXTRACDRPOREAL SHOO< WAVE THERAPY FOR CHIIDREN,
Research on the effects of extracorporeal shock waves on the mucosa and smooth muscle of the urinary tract is currently being conducted using an in vivo
rabbit urinary bladder model.
Of particular interest
is the effect on the mucosa with regard to changes in bacterial adherence. Anesthetized rabbits were catheterized, placed on a modified gantry and treated with
the I ithotripter. The shock waves were focused on the urinary bladder after filling it with 20ml of contrast material.
One thousand shock waves were delivered at
a generator voltage of 18 kv. The animals were sacrificed immediately following ESWL and compared to a sham treated group. Al I rabbits developed gross hematuria. Laporotomies performed on the treated rabbits showed intraperitoneal blood, retroperitoneal and mesenteric hematomas, and bruising of the intrapelvic intestinal walls. The urinary b 1adders had edema and hematomas within the wa 11 s. Despite
the gross physical findings, the bacterial adherence to the bladder mucosa of the acutely treated rabbits was unchanged compared to the control group.
David T. Mininberg, M.D., New York, New York Robert A. Riehle, Jr., M.D. Presentation to be made by: David T. Mininberg,
M. D.
Fifteen children ranging in age from three to seventeen years received seventeen extracorporeal shock wave li thotripsy treabrents. The minimum followup period has been three rronths. There have been no complications to date requiring instrurrentation. Seven of seventeen treabrents resulted in stone free kidneys. Nine of seventeen patients had residual insignificlffit stone fragrrents. One patient had no response to treatrrent. Stone size averaged 13.6 cm. with a rMge of 3-25 cm. Smaller stones were rrore successfully disintegrated without residual fragments than large stones. The persistent fragment rate was essentially the sa:rre whether the stones were Class A, in the kidney pelvis, or Class B, complex or ureteral stones. The average number of shock waves delivered was 1485, with a range from 600-2000.
The chronic effects are now
being studied and will also be reported.
282A
713
EXPERIENCE WITH EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY IN THE PEDIATRIC AGE GROUP. ,>Janet E. Smith, Howard Pollack, Philadelphia, PA; (Presentation by *Janet E. Smith) Since June 1985, 12 pediatric patients (13 kidney/
EXTRACORPOREAL SHOCK WAVE LI THOTR I PS Y FOR CAL CUL I IN HORSESHOE KIDNEYS. *Janet E. Smith, Howard Pollack, Keith N. Van Arsdalen, Philadelphia, PA; (Presentation by *Janet E. Smith) One out of 400 people (0.25%) have a horseshoe
ureters) have been treated with extracorporeal shock wave
lithotripsy (ESWL) at the Hospital of the University of Pennsylvania.
The average age was 11.7 years with an av-
kidney. The incidence of renal calculi is 20% making the overall number of these patients not insignificant.
erage weight and height of 35.5kg and 125 cm, respectively. The smallest chi Id treated was a 15 kg, 95 cm, 3 year old male. Procedures performed prior to ESWL included insertion of a ureteral catheter (3) and percutaneous nephrostomy placement (1). The average number of shock
Extracorporeal shock wave lithotripsy (ESWL) has dramatically changed the management of urol ithiasis but controversy exists regarding the feasibility of treating these patients with this modality due to anatomic and functional
waves given was 1,500 delivered at an average voltage of
these kidneys may make the distance between the flank and the kidney too great to get the calculus into the focal point (F 2). Calculi in medial calyces may also be obscured by the spine in the obi ique position making localization more difficult. Lastly, the outflow may not be dependent thereby impairing the spontaneous passage of the fragments. Over the last 18 months, 14 patients with a horseshoe kidney have presented to the Hospital of the
17 kv. Only one chi Id (7%) required additional procedures and retreatment after the initial ESWL. The only complication was a child with a pelvic kidney who had an episode of blood in her stool 2 days after ESWL. This spontaneously resolved. Of 8 children who have had their 3 month fol low up, 8 (100%) were free of residual fragments.
In conclusion, pediatric patients with calculi
considerations.
The more anterior anatomic position of
can be successfully treated with ESWL with minor mech-
University of Pennsylvania for evaluation and treatment.
anical modifications, minimal complications, and an acceptable rate of adjunctive procedures but care must be taken in patient selection.
Twelve of these patients (86%) were able to have their calculi treated with ESWL. The largest patient weighed 255 pounds. Three of 12 patients (25%) required a second treatment. The pitfalls involved in management as wel I as t.be- use of 11 dry runs 11 pre-operatively, modifications of the gantry, and the use of retrograde catheters in overcoming these problems are discussed. In conclusion, most patients with calculi in a horseshoe kidney can be man-
aged with ESWL primarily with minimal technical modifications.
714
715
EFFECTS OF EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY ON BACTERIAL ADHERENCE IN RABBIT URINARY BLADDERS. Keith N. Van Arsdalen, *Ashok K. Batra, Philadelphia, PA; (Presentation by Keith N. Van Arsdalen)
EXTRACDRPOREAL SHOO< WAVE THERAPY FOR CHIIDREN,
Research on the effects of extracorporeal shock waves on the mucosa and smooth muscle of the urinary tract is currently being conducted using an in vivo
rabbit urinary bladder model.
Of particular interest
is the effect on the mucosa with regard to changes in bacterial adherence. Anesthetized rabbits were catheterized, placed on a modified gantry and treated with
the I ithotripter. The shock waves were focused on the urinary bladder after filling it with 20ml of contrast material.
One thousand shock waves were delivered at
a generator voltage of 18 kv. The animals were sacrificed immediately following ESWL and compared to a sham treated group. Al I rabbits developed gross hematuria. Laporotomies performed on the treated rabbits showed intraperitoneal blood, retroperitoneal and mesenteric hematomas, and bruising of the intrapelvic intestinal walls. The urinary b 1adders had edema and hematomas within the wa 11 s. Despite
the gross physical findings, the bacterial adherence to the bladder mucosa of the acutely treated rabbits was unchanged compared to the control group.
David T. Mininberg, M.D., New York, New York Robert A. Riehle, Jr., M.D. Presentation to be made by: David T. Mininberg,
M. D.
Fifteen children ranging in age from three to seventeen years received seventeen extracorporeal shock wave li thotripsy treabrents. The minimum followup period has been three rronths. There have been no complications to date requiring instrurrentation. Seven of seventeen treabrents resulted in stone free kidneys. Nine of seventeen patients had residual insignificlffit stone fragrrents. One patient had no response to treatrrent. Stone size averaged 13.6 cm. with a rMge of 3-25 cm. Smaller stones were rrore successfully disintegrated without residual fragments than large stones. The persistent fragment rate was essentially the sa:rre whether the stones were Class A, in the kidney pelvis, or Class B, complex or ureteral stones. The average number of shock waves delivered was 1485, with a range from 600-2000.
The chronic effects are now
being studied and will also be reported.
282A