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Year : 1999  |  Volume : 15  |  Issue : 1  |  Page : 10-17

Safety and efficacy of endourology and SWL in paediatric calculus disease in a developing country.

Department of Urology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow

Correspondence Address:
A Mandhani
Department of Urology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow

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Source of Support: None, Conflict of Interest: None

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Objective : To assess the safety and efficacy of endourology and SWL in the management of paediatric calculus disease in a developing country. Patients and Methods : The study comprised of 110 patients of less than 15 years of age (range : 8 months to 15 years; mean: 9.9 years) who underwent treatment between June 1989 and July 1997 in a major urological centre in India. The clinical presentations, mode of therapy and the outcome were analysed retrospectively. There were stones in 120 units with 98 renal, 14 ureteric and eight vesical stones, Pain, urinary tract infection and haematuria were the frequent presenting complaints. Percutaneous nephrolithotomy (PNL) was undertaken for 27 renal stones. Shock wave lithotripsy (SWL) was given for 58 renal stones and one ureteric stone. Ureteroscopic retrieval (URS) was done for eight ureteric stones, percutaneous cystolithotomy (PCL) for four vesical stones. Open surgery was performed in rest of the 22 units. The youngest children who underwent PNL and PCL were each seven years old. The body size of these children was compared with the body size of the children of the West by standard nomograms to assess kidney size indirectly. Results : In PNL group, average stone size was 3.5 cm. Total clearance rate was 85 percent with re-look rate of 1.45 percent. However when SWL was combined with PNL total clearance rate was achieved in 96 percent of the patients. In SWL monotherapy, stones were of smaller size (av. 2.2 cm) which required mean of 2650 shocks in 3.14 sittings. Fragmentation rate was 85 percent with clearance rate of 76 percent, 88 percent of ureteric stones could be removed with ureteroscopy. All the 4 cases of PCL for bladder stones of size ranging from 2 to 6 cm were cleared completely. The most common indication for open surgery was parental insistence for a one go procedure due to financial constraints and concomitant surgical reconstruction for associated anomalies. The average size of an Indian child is smaller for age by one and a half to two years in their height and weight repectively.

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