Background/Aims/Objectives: To evaluate the outcomes and ionizing radiation (IR) exposure of children with cystine stones (CS) using different shockwave lithotripsy (SWL) guidance modalities. Methods: Data from pediatric patients with renal stones treated between January 2009 and August 2015 were retrospectively reviewed. Outcome results and IR exposure in patients undergoing fluoroscopy (FL)-guided SWL and ultrasonography (US)-guided SWL were compared. First-time stone formers and those treated with SWL and with complete follow-up data, including post-treatment stone analysis confirming CS were included. Results: Forty-four patients (16 girls and 28 boys) met the inclusion criteria. Results of SWL performed in 51 kidneys were analyzed. After the SWL, 41 (80.4%) of 51 kidneys were stone free, and 10 (19.6%) had clinically insignificant residual fragments (≤3 mm) or unfragmented stones. The success rates differed between patients in Group-FL (60%) and Group-US (93.5%) (p = 0.008). Single-session success rates were higher, and prospects of retreatment were lower in Group-US (p = 0.000 and p = 0.002, respectively). In addition, overall complications were significantly lower in Group-US (p = 0.042). Overall IR exposure was higher in Group-FL (p = 0.013). Conclusions: US-guided SWL is more effective for pediatric CS and should be considered a preferred treatment to reduce IR doses in children.

Keywords:
Pediatrics, Radiation, Cystine, Cystinuria, Lithiasis, Lithotripsy
1.
Muslumanoglu AY, Binbay M, Yuruk E, Akman T, Tepeler A, Esen T, Tefekli AH: Updated epidemiologic study of urolithiasis in Turkey. I: changing characteristics of urolithiasis. Urol Res 2011;39:309-314.
2.
Romero V, Akpinar H, Assimos DG: Kidney stones: a global picture of prevalence, incidence, and associated risk factors. Rev Urol 2010;12:e86-e96.
3.
Tekgul S, Dogan HS, Erdem E, Hoebeke P, Kocvara R, Nijman JM, Radmayr C, Silay MS, Stein R, Undre S: Guidelines on Paediatric Urology, 2015.
4.
Stapleton FB: Childhood stones. Endocrinol Metab Clin North Am 2002;31:1001-1015, ix.
5.
Turk C, Knoll T, Petrik A, Sarica K, Skolarikos A, Straub M, Seitz C: Guidelines on Urolithiasis, 2015.
6.
Cranidis AI, Karayannis AA, Delakas DS, Livadas CE, Anezinis PE: Cystine stones: the efficacy of percutaneous and shock wave lithotripsy. Urol Int 1996;56:180-183.
7.
Worcester EM, Parks JH, Evan AP, Coe FL: Renal function in patients with nephrolithiasis. J Urol 2006;176:600-603; discussion 603.
8.
Paterson RF, Lifshitz DA, Kuo RL, Siqueira TM Jr, Lingeman JE: Shock wave lithotripsy monotherapy for renal calculi. Int Braz J Urol 2002;28:291-301.
9.
Slavković A, Radovanović M, Sirić Z, Vlajković M, Stefanović V: Extracorporeal shock wave lithotripsy for cystine urolithiasis in children: outcome and complications. Int Urol Nephrol 2002;34:457-461.
10.
Chow GK, Streem SB: Contemporary urological intervention for cystinuric patients: immediate and long-term impact and implications. J Urol 1998;160:341-344; discussion 344-345.
11.
Badawy AA, Saleem MD, Abolyosr A, Aldahshoury M, Elbadry MS, Abdalla MA, Abuzeid AM: Extracorporeal shock wave lithotripsy as first line treatment for urinary tract stones in children: outcome of 500 cases. Int Urol Nephrol 2012;44:661-666.
12.
The Alliance for Radiation in Pediatric Imaging: Imagegently Fluoroscopy. http://www.imagegently.org/Roles-What-can-I-do/Parent/Fluoroscopy (accessed February 22, 2016).
13.
Colang JE, Killion JB, Vano E: Patient dose from CT: a literature review. Radiol Technol 2007;79:17-26.
14.
Strohmaier WL: Imaging in pediatric urolithiasis - what's the best choice? Transl Pediatr 2015;4:36-40.
15.
Lingeman JE, Newman DM (eds): Shock Wave Lithotripsy 2. Boston, Springer Science+Business Media BV, 2013, p 462.
16.
Richardson RB: Stem cell niches and other factors that influence the sensitivity of bone marrow to radiation-induced bone cancer and leukaemia in children and adults. Int J Radiat Biol 2011;87:343-359.
17.
Egilmez T, Tekin MI, Gonen M, Kilinc F, Goren R, Ozkardes H: Efficacy and safety of a new-generation shockwave lithotripsy machine in the treatment of single renal or ureteral stones: experience with 2670 patients. J Endourol 2007;21:23-27.
18.
Dindo D, Demartines N, Clavien PA: Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004;240:205-213.
19.
Hockley NM, Lingeman JE, Hutchinson CL: Relative efficacy of extracorporeal shock wave lithotripsy and percutaneous nephrostolithotomy in the management of cystine calculi. J Endourol 1989;3:273-285.
20.
Zeren S, Cakir H: Pediatric percutaneous nephrolithotomy (PCNL): overcoming the difficulties; in Al-Kandari AM, Desai M, Shokeir AA, Shoma AM, Smith AD (eds): Difficult Cases in Endourology. London, Springer, 2013, pp 279-290.
21.
Ristau BT, Dudley AG, Casella DP, Dwyer ME, Fox JA, Cannon GM, Schneck FX, Ost MC: Tracking of radiation exposure in pediatric stone patients: the time is now. J Pediatr Urol 2015;11:339.e1-e5.
22.
Osman M, Wendt-Nordahl G, Heger K, Michel MS, Alken P, Knoll T: Percutaneous nephrolithotomy with ultrasonography-guided renal access: experience from over 300 cases. BJU Int 2005;96:875-878.
23.
Aksoy Y, Yapanoğlu T, Özbey İ: The efficacy and safety of extracorporeal shock wave lithotripsy in children. Eurasian J Med 2009;41:120-125.
24.
Landau EH: Modern stone management in children. Eur Urol Suppl 2015;14:12-19.
25.
Ozden E, Mercimek MN: Percutaneous nephrolithotomy in pediatric age group: assessment of effectiveness and complications. World J Nephrol 2016;5:84-89.
26.
Wrixon AD: New ICRP recommendations. J Radiol Prot 2008;28:161-168.
27.
Worcester E: Cystine Stones; in Goldfarb S (ed): Uptodate. UpToDate, Waltham, 2015 (accessed February 4, 2016).
28.
Patel SR, Wagner LE, Lubner MG, Nakada SY: Radiopacity and hounsfield attenuation of cystine urolithiasis: case series and review of the literature. J Endourol 2014;28:472-475.
© 2016 S. Karger AG, Basel
2016
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.