微创经皮肾穿刺取石治疗小儿上尿路结石

目的探讨微创经皮肾穿刺取石术（minimally invasive percutaneous nephrolithotomy,MPCNL）治疗小儿上尿路结石的效果。方法回顾分析35例MPCNL治疗小儿上尿路结石的临床资料,男29例,女6例,平均年龄8.5岁（4～13岁）。输尿管上段结石7例,肾结石28例,均为一侧上尿路结石。伴肾盂输尿管连接部（ureteropelvic junction obstruction,UPJ）梗阻2例。结果MPCNL治疗成功31例,成功率88.6%（31/35）,其中一期结石完全清除率87.1%（27/31）,二期结石完全清除率75%（3/4）。2例结石位于UPJ致结石下方狭窄,2例皮肾穿刺失败,改开放手术。结论MPCNL是治疗小儿肾结石和输尿管上段结石安全、有效的方法。     

The aetiological and clinical pattern of childhood urolithiasis in Saudi Arabia

The clinical and aetiological pattern in 85 stone-forming children presenting to an integrated nephrourological service in Riyadh is reviewed. All patients were below the age of 15 years, the male to female ratio being 2∶1. Only 2 children presented with bladder calculi. The remaining all had upper tract stone and, in 12 cases, these were bilateral. Of 34 calculi recovered for analysis, one-third was predominantly calcium oxalate and a further third was composed of uric acid or urate. Four patients had cystine stones and the remaining 7 presented mixed calcium stones, 6 (17.6%) being struvite and infection-related. Of the 85 patients 55 were treated successfully with extracorporeal shock wave lithotripsy, 16 underwent surgery and 7 had their stones removed by endourological procedures. In the remaining 7 children, stones dissolved or were passed spontaneously during medical therapy. Nine children (10.6%) showed a primary metabolic defect leading to their stone formation, 10 (11.8%) had a predisposing anatomical anomaly and 15 (17.6%) presented with urinary tract infection. Of the remaining 51 patients (60%) with idiopathic disease, 6 showed hypercalciuria on investigation and 2 children may have formed their stones due to prolonged recumbency.     

Clinical studies on childhood urolithiasis during the past 22 years

We have studied retrospectively 68 children who presented with urolithiasis between 1965 and 1986. Male to female ratio was 1.83 to 1 and the mean age was 9.5 years. Fifty four children (79%) had calculi in the upper urinary tract, 9 (13%) had in the lower, and 4 (6%) had calculi both in the upper and lower urinary tract. The most common presenting symptoms were gross hematuria (53%) and abdominal or flank pain (38%). Predisposing factors could be found only in 21 children (31%). Twenty four of the 68 patients (35%) had open surgery and 16 patients (24%) passed their stones spontaneously. Twenty one stones were analyzed by infrared spectroscopy. Infectious stone was more frequent than in adult cases. Among children five years old and younger, infectious stone was the most frequent. Among children over five years old, the number of idiopathic calcium stone has been on the increase with the years.     

延安地区泌尿系结石成分分析的研究

目的利用红外光谱法测定延安大学附属医院泌尿外科手术获得的泌尿系结石成分,探讨延安地区泌尿系结石成分与年龄、性别等关系,比较上、下尿路结石成分特点,分析延安地区泌尿系结石发生的流行病学情况,为临床制定有效的个体化治疗及预防措施提供参考依据。方法收集2013年1月至2017年1月在延安大学附属医院泌尿外科治疗1984例尿路结石患者的年龄、性别、结石部位等临床资料,对比分析延安地区泌尿系结石在不同年龄、不同性别、不同解剖部位的分布特点。结果在1984例泌尿系结石的患者中,按每10岁年龄大小分组排序,统计各年龄阶段泌尿系结石发病情况,男性患者有1346例,女性患者有638例,男性年龄(50.23±14.48)岁,女性年龄(47.87±14.51)岁,男、女患者比例约2.11∶1。在66~75岁年龄段,尿路结石发病率性别差异具有统计学意义(P<0.05)。结石成分以混合性结石为主,以混合性结石为主,共1582例,占79.76%。其中1665例(83.92%)为上尿路结石,上、下尿路结石的比例为5.22∶1,其余为肾结石合并膀胱结石。上尿路结石中男性1062例,女性603例,男女比例为1.76∶1;下尿路结石中男性284例,女性35例,男女比例为8.11∶1。青壮年(年龄≤45岁)泌尿系结石患者草酸钙为主结石、感染性结石多见;中老年(年龄>45岁)泌尿系结石者草酸钙为主结石、尿酸类结石多见。感染性结石患者性别差异具有统计学意义(P<0.05)。结论在延安地区男性较女性更容易患泌尿系结石。同时,不同年龄段结石构成成分具有差异。对于年龄≤45岁患者,主要以草酸钙为主结石、感染性结石多见,这与结石整体发病率基本一致;而对于年龄>45岁患者,主要以草酸钙为主结石、尿酸性结石多见。表明对于不同年龄段的结石患者,可以根据上述结果在结石的预防和治疗上综合考量,给予明确而更加合理的治疗。     

Childhood urolithiasis in Iran with special reference to staghorn calculi

Between 1972 and 1984 148 children with urolithiasis were studied and managed at the University Clinic Children's Hospital of Teheran. In 125 children the calculi were in the upper and in 23 children in the lower urinary tract. The maximum incidence was between the ages of 5-8 and 12 years. 25 children had malformations and 16 had metabolic disorders. Cystinuria was observed in 6 and xanthinuria in 3 cases. The main constituents of calculi analyses in the upper urinary tract were calcium oxalate followed by ammonium acid urate. In the lower urinary tract ammonium acid urate and oxalate were seen with equal frequency, followed by uric acid. 16 children had staghorn calculi with an age profile of 5-13 years. Predominant symptoms were flank pain and gross hematuria. In 4 cases the calculi were bilateral. The calculi were removed successfully by pyelotomy and extensive pyelolithotomy. In 2 cases with more branched-out staghorn calculi and separate fragments, a logitudinal extensive nephrotomy was performed. In the absence of recurrent stones, renal growth and function were satisfactory postoperatively. In the majority of the cases the analyses of the staghorn calculi revealed phosphate.     

Giant urinary tract calculi: A case series

Background: A giant urinary tract calculus is not common in modern urological practice. The bladder has been known to harbour very large stones, weighing hundreds of grams, some with bearable symptoms, for a long time. These giant stones account for less than 1% of all urinary tract calculi. The aim of the present report is to highlight our management of a series of giant urinary tract calculi. Methods: A series of 14 patients were seen over 5 years (2004–2009) with giant urinary tract calculi and were studied in detail using their hospital records. Their biodata, clinical presentation, presence of urinary tract obstruction or infection, diagnostic investigations, operative management, and physical and chemical characteristics of the calculi were reviewed. Results: There were 13 males and one female, and their ages ranged between 4 and 79 years (median 30.5). Ten patients had bladder calculi, one ureteric in combination with a staghorn renal calculus, a second stone in the urethra and two huge staghorn calculi in non‐functioning kidneys. The mean weight of the calculi was 153.3 ± 69.6 (range 25–300 g) and the chemical compositions were mainly calcium oxalate, struvite (triple phosphate) and calcium carbonate. All the stones were radio‐opaque and two were associated with non‐functioning kidneys, and there was no congenital anatomical defect causing obstruction in any of the patients. Conclusion: Giant urinary tract calculi are most common in the male urinary bladder and are managed by open surgery with very good outcome. There were no anatomical abnormalities causing narrowing in the urinary tract in any of the cases.     

Experience with childhood urolithiasis. Report of 196 cases

A total of 196 children with urinary calculi were treated surgically. Their ages ranged from 1 to 14 years. The male:female ratio was 3:1. Stones were located in the kidney in 96 patients, in the bladder in 52 and in the ureters in 32. Multiple organ involvement was present in 16 patients and associated urinary tract anomalies were found in 11. Stone analysis revealed calcium oxalate and phosphate stones in 121 patients, struvite stones in 60 and uric acid stones in 15.     

Extracorporeal shock wave lithotripsy in children: Results and short-term complications

AIM: The introduction of extracorporeal shock wave lithotripsy represented an important evolution in urinary tract lithiasis management. The aim of this study is to describe the results of extracorporeal shock wave lithotripsy for the treatment of urinary tract lithiasis in children, focusing on the index of elimination of the calculi and the complications occurring during the procedure and during the following three months. METHODS: From September 1991 to July 2002, 135 children between one and 12 years, suffering from urinary tract lithiasis underwent extracorporeal shock wave lithotripsy. A retrospective analysis of these patients was carried out. RESULTS: One hundred and ninety-five calculi ranging in size from 5.0 mm to 20.0 mm were treated, out of which 147 were found in the kidneys and 48 in the ureter. Urinary tract dilation was presented by 30% of the children at the time of the procedure. After extracorporeal shock wave lithotripsy 75.8% of the calculi were eliminated: 64.1% were stone-free and 11.7% had < or = 4 mm stones. Ureteral calculi and 5-10 mm stones responded better than the kidney and 11-20 mm stones (P = 0.027 and P = 0.012, respectively). No differences were detected according to the calculi location, whether in the ureter or kidney (P = 0.637 and P = 0.703, respectively). The shock wave intensity of 14kv was as efficient as the higher voltage. Short-term complications were observed in 23.7%, characterized by fever and pain. CONCLUSION: In children, extracorporeal shock wave lithotripsy proved to be able to eliminate 75.8% of the treated calculi and 83.7% of the patients presented a complete or partial response. Complications were observed in 23.7% of patients, and pain was the most frequent symptom.     

泌尿系结石成分450例分析

目的分析泌尿系结石患者的发病年龄及性别特点,探讨结石部位与患者年龄及性别的关系,根据结石不同成分采用不同预防措施。方法应用化学分析法对450例尿路结石做成分分析,结合临床资料,对尿路结石患者发病年龄、性别、结石部位及结石成分做对比分析。姑杲男性患者321例,高发年龄21～60岁;女性129例,高发年龄41～60岁;男性发病率是女性的2．49倍。发病部位肾脏结石319例（70．8％）,输尿管结石115例（25．6％）,膀胱结石16例（3．6％）;单一成分结石275例（61％）,其中单纯草酸钙结石260例（57．7％）,两种及以上混合成分结石175例（39．0％）。结论尿路结石的发病率及发病年龄存在着明显的性别差异;尿路结石发病部位主要为上尿路结石;单一成分结石以草酸钙为主,约40％的尿路结石为两种及以上混合成分结石。     

Extracorporeal shock wave lithotripsy in children. Efficacy, complications and long-term follow-up.

OBJECTIVES: Extracorporeal shock wave lithotripsy (ESWL) is effective and safe for the treatment of upper urinary tract calculi in adults. Some speculations concerning possible damages from ESWL on the growing kidney have been raised. METHODS: From January 1990 to December 1998, 64 children (30 girls and 34 boys; 8 months to 15 years old, mean 5.6 years) with a total of 83 stones of the upper urinary tract were treated by ESWL (Lithostar). Preoperative evaluation included history, physical examination, routine blood tests, urinalysis, urine culture, intravenous urography and optional renal scintigraphy. The impulse rate per treatment varied from 750 to 4,000 (mean 2,996). After acute treatment, routine follow-up included renal ultrasound, blood pressure controls, laboratory tests and eventually plain film X-ray. RESULTS: Successful fragmentation of the stones was achieved in all patients. In 54% the patients were free of stones treated at the time of discharge. At 3 months after treatment radiographic studies showed no residual fragments in 80% of the treated children. 83% of the treated stones were cleared entirely. The remaining fragments were clinically insignificant. An average of 2.5 ESWL treatments per child in general anesthesia were required. Stone analysis showed 20 calcium oxalate, 38 calcium phosphate, 12 struvite, 2 uric acid and 9 cystine calculi. Ureteral stents were placed in 43%. No significant urinary infection was seen under antibiotic prophylaxis. Only 3 children showed a recurrence (1 x cystinuria with low compliance and 2 x struvite). There was no case of renal scarring. No change in renal function or blood pressure was found compared to the preoperative values. Hematuria and proteinuria disappeared in all children who were free of stones. Renal ultrasound revealed no growth difference between treated and untreated renal units. CONCLUSIONS: In childhood, ESWL is an efficacious and safe treatment of stones of the upper urinary tract. The long-term follow-up after ESWL with a second-generation lithotriptor did not show any signs of damage to the growing kidney. Sometimes repeated ESWL treatments are justified by the low rate of complications.     

Percutaneous removal of upper urinary tract calculi: experience with ultrasonic lithotripsy

From October 1983 to March 1985, the authors removed upper urinary tract calculi percutaneously in 102 patients. In 89 patients, stones required disruption with an ultrasonic lithotriptor before removal. Fifty-two patients had a stone in the renal pelvis and 20 had calyceal stones only; 21 had stones at both sites and 9 had a stone in the upper ureter. Complete removal of all stone material was achieved in 67 of 68 patients with a solitary calculus, in 13 of 26 with multiple calculi and in 6 of 8 with ureteric calculi. Complications were minimal; three patients had pulmonary edema postoperatively as a result of excessive absorption of irrigating fluid, and one patient sustained a perforation of the descending colon. The mean postoperative hospital stay was 6.8 days and patients were able to return to work a few days after their discharge from hospital. Percutaneous stone removal is a safe and effective procedure and is the surgical procedure of choice for the removal of upper urinary tract calculi.     

经膀胱镜输尿管双J管置入治疗小儿上尿路梗阻

目的探讨经膀胱镜留置输尿管双J管在小儿上尿路梗阻中的应用价值。方法回顾性分析2014年12月~2018年5月45例膀胱镜输尿管双J管置入治疗上尿路梗阻的资料,其中先天性肾积水20例,急性输尿管结石梗阻23例,肾盂离断成形术后积水复发2例。均经膀胱镜逆行置入F3、F4或F4.7双J管。结果2例先天性肾积水和3例急性输尿管结石梗阻未能置入输尿管双J管,其余40例留置双J管位置良好。先天性肾积水18例均于术后6个月取出双J管,8例随访3~4年积水未加重,10例因积水加重行腹腔镜肾盂离断成形术;急性输尿管结石梗阻20例于1~2周拔除输尿管双J管,二期输尿管镜钬激光碎石成功;肾盂离断成形术后积水复发2例均于术后6个月拔除输尿管双J管,1例随访1年5个月肾积水无再次加重,1例因肾积水再次加重于拔管后20天行腹腔镜肾盂离断成形术。结论输尿管双J管置入可有效缓解小儿上尿路梗阻,达到缓解肾脏压力的目的,可作为婴幼儿和儿童上尿路梗阻的一线治疗方案。     

Clinical studies on thirty-two cases of childhood urolithiasis

We evaluated 32 patients with urinary calculi under 16 years of age over the past 14 years since the founding of the Department of Urology, Kinki University School of Medicine. They comprised 0.8% of the total urolithiasis patients. They consisted of 18 boys and 14 girls with a male-to-female ratio of 1.29. The average age was 8.7 years for boys and 10.4 years for girls without any marked peak. The most frequently chief complaint was hematuria which was present in 15 cases (47%). Although pyuria was seen in seven cases (22%), urinary bacterial culture was positive only in 5. The underlying diseases could be diagnosed in 13 cases (41%), of which eight cases (62%) developed metabolic disorder. The sites of calculi were determined in 29 cases (91%), of which 28 had stones in the upper urinary tract. Surgical treatment was performed on 16 cases in 17 sessions. Ureterolithotomy was done in as many as five cases, followed by pyeloplasty in four cases. Nephrectomy was performed in only one case. There was only one case which had been treated with extracorporeal shock-wave lithotripsy (ESWL). The composition of calculi was found in 21 cases (66%), the majority or 13 cases (57%) of which had calcium-containing stones. Nevertheless, there was no case of hypercalciuria. When compared to the previous reports in Japan, it was worthy of note that calculi in the upper urinary tract and calcium-containing stones had higher incidences. It is expected that more patients will be treated with ESWL in the future.(ABSTRACT TRUNCATED AT 250 WORDS)     

Urolithiasis in childhood: current management

During the past 12 years, 62 children with urinary stones have been treated at the Children's Hospital of Philadelphia. The most common presenting symptoms were abdominal or flank pain (45%), recurrent or persistent pyuria (35%), and gross hematuria (21%). Twenty-two patients had associated congenital urologic anomalies. Infection-related struvite stones were most common and were found in 18 children, of whom 15 were found to have anatomic abnormalities. Eighteen of 28 children evaluated for a metabolic cause were found to have an abnormality, most frequently hypercalciuria. No predisposing factors could be found in 16 of the 62 patients. Forty-four (87%) children had upper urinary tract stones. Twelve of 15 bladder stones were in children with a neuropathic bladder and all were related to infection. Treatment was directed to the correction of anatomic and metabolic predisposing causes, as well as to removing the stones. Fifteen patients passed stones ranging in size from 2 to 6 mm. Forty-six surgical procedures were performed in 43 children. Pyelolithotomy and cystolithotomy were the most frequent procedures. There were three residual stones and five recurrences. Of the 29 operations for upper urinary stones reviewed, 17 might today be considered suitable for percutaneous nephrostolithotripsy or extracorporeal shockwave lithotripsy. Possible future stone management will be discussed in light of this analysis.     

Urolithiasis in Tunisian children: a study of 120 cases based on stone composition

The composition of urinary stones in children depends on socioeconomic conditions and hygiene, geographical area, and dietary habits. We analyzed urinary stones from 120 consecutive Tunisian children (81 males, 39 females) aged 5 months to 15 years. The stone was located in the upper urinary tract in 91 cases (76%). Stone analysis included both a morphological examination and an infrared analysis of the nucleus and the inner and peripheral layers. The main components of bladder calculi were whewellite (69%) and struvite (22%), whereas the main component of upper urinary tract calculi was whewellite (67%). The nucleus of bladder stones was composed of ammonium urate (45%), struvite (28%), cystine (10%), and carbapatite (7%). The nucleus of kidney and ureteral calculi was mainly composed of ammonium urate (38%), whewellite (24%), carbapatite (13%), or struvite (11%). Based on stone composition, urinary tract infection was involved in the nucleation or growth of a third of calculi. Endemic urolithiasis involving simultaneous nutritional, metabolic, and infectious factors, and defined by its nucleus composed of ammonium urate without struvite, represented 40% of cases. Exclusive metabolic factors – including genetic diseases such as primary hyperoxaluria, cystinuria, and hypercalciuria – were responsible for less than 25% of cases. Received: 6 March 1998 / Revised: 22 March 1999 / Accepted: 22 March 1999     

PERCUTANEOUS NEPHROLITHOTOMY IN THE PEDIATRIC POPULATION

PURPOSE: Percutaneous nephrolithotomy is an established technique used in children with renal calculi. We review our experience with percutaneous nephrolithotomy for treating nephrolithiasis in childhood. MATERIALS AND METHODS: We retrospectively reviewed the records of children who underwent percutaneous nephrolithotomy procedures for renal calculi from 1985 to 1996. Antegrade percutaneous access was obtained in all patients and the tract was dilated to 24F. Grasper forceps, ultrasound and/or electrohydraulic lithotripsy was used to remove and disintegrate stones. In all patients a nephrostomy tube was placed intraoperatively, and a plain abdominal x-ray and nephrostogram were done postoperatively. The nephrostomy tube was removed after ensuring free drainage down the ureter and no untoward effects from clamping. Complete anatomical and metabolic evaluation was performed in all cases. Patients were followed 2 to 6 weeks, and 3 and 6 months postoperatively with a plain abdominal x-ray and excretory urography or renal ultrasound. RESULTS: In 5 boys and 3 girls (9 renal units) 4 to 11 years old (mean age 6.4) a total of 10 percutaneous nephrolithotomy procedures were performed. At presentation 6 children had flank and/or abdominal pain, 5 gross hematuria and 3 urinary tract infection. Three patients had associated metabolic abnormalities. One patient with a staghorn calculus had hydronephrosis and multiple infundibular stenoses. No underlying urological anatomical abnormalities were noted in the remaining cases. Four renal units that were obstructed at presentation required initial nephrostomy tube insertion. Average operative time was 131.8 minutes (range 58 to 240). An 87.5% stone-free rate was achieved using percutaneous nephrolithotomy monotherapy. Percutaneous nephrolithotomy was not successful for eradicating a staghorn stone in 1 patient. Hypothermia developed in 2 patients in whom operative time exceeded 150 minutes. No blood transfusions were required. CONCLUSIONS: Percutaneous nephrolithotomy is safe and effective in children, and should be considered a viable management option. However, staghorn calculi may require alternative management, particularly in the setting of underlying anatomical abnormalities. Children with renal calculi should undergo a complete anatomical and metabolic assessment with the institution of medical therapy, as appropriate.     

Urethral calculi.

The diagnosis and management of 34 men and 13 women with urethral calculi are reviewed. A majority of patients presented with dysuria, weak stream and perineal pain. Diagnosis was made radiographically in only 42 per cent but was confirmed in all patients who underwent cystourethroscopy. All patients had lower urinary tract lesions or previous prostatic operations and 47 per cent were infected. Migrant urethral calculi were encountered 10 times more often than were native stones and a metabolic cause was found in 10 of 18 patients studied. In men penile urethral calculi were removed transurethrally and all bulbous and most posterior urethral stones were guided endoscopically into the bladder. Most of these stones were irrigated out or removed by transurethral litholapaxy; the remaining few, together with vesical calculi, required cystolithotomy. In all 13 women calculi were removed at the time of urethral diverticulectomy. A majority of 17 men (76.5 per cent) and the 4 women who were followed for an average of 5.3 years have remained free of trouble.     

Recurrent and residual renal calculi in children

One hundred and thirteen children with non-metabolic urinary tract calculi were operated on between 1960 and 1983. One hundred were followed up for 3 to 17 years (mean 8.2). Seventeen children (15%) developed recurrent calculi after complete clearance at the initial operation and in 13 of these the stones recurred within 5 years. Proteus urinary infection was a constant feature of stone recurrence. Five patients required re-operation for removal of the recurrent calculus. Small residual caliceal fragments were left behind in 17 children but only 3 required surgical removal.     

B超引导下经皮肾穿刺输尿管镜取石术治疗小儿上尿路结石的临床疗效分析

目的 探讨B超引导下经皮肾穿刺输尿管镜取石术治疗小儿上尿路结石的临床疗效和安全性.方法 回顾性分析2012年至2015年80例(82例次)小儿上尿路结石的临床资料,年龄7～71个月,平均(33.1±17.3)个月,结石大小(0.8～2.9) cm,平均(1.47 ±0.43)cm.左侧34例,右侧44例,双侧2例(无尿、肾功不全),单发结石46例,多发结石34例,肾盂、肾盏结石64例,输尿管上段结石5例,6例肾结石合并膀胱结石,4例肾结石合并有输尿管结石,1例肾结石合并同侧输尿管结石及膀胱结石,4例患儿既往有肾盂切开取石病史.先输尿管镜下患侧输尿管逆行留置4-5F输尿管导管,后俯卧位,B超引导下穿刺目标肾盏,16F Peel-away鞘作为手术通道,应用WOLF输尿管镜(WOLF 8/9.8F)气压弹道碎石取石.结果 手术治疗82例次,其中78例次一次取净结石,4例次先一期建立通道引流尿液改善肾功控制感染后二期取石,4例出现残留结石,术后第3天净石率为95.2％.手术时间(建立通道碎石开始手术结束)为15～ 90min,平均(33±21.7) min.术后HGB下降(9.8±7.8) g/L,HCT变化(0.0375±0.0367).术后平均住院时间3～11d,平均(6±1.6)d,术后1例患儿出现胸腔积液,15例出现发热,无严重并发症发生.术后随访1个月,患儿均未见结石复发.结论 B超引导下经皮肾穿刺输尿管镜取石术治疗小儿肾和输尿管上段结石安全、有效.     

Extracorporeal Shock Wave Lithotripsy as First Line Treatment Alternative for Urinary Tract Stones in Children: A Large Scale Retrospective Analysis

PurposeManagement of urinary tract stones in children represents a challenging problem. In this study we retrospectively analyzed our experience with extracorporeal shock wave lithotripsy (SWL) in children.Materials and MethodsDuring a 12-year period 408 urinary tract calculi in 344 children (mean age 8.7 ± 3.9 years, range 6 months to 14 years) were managed with the Lithostar Plus lithotriptor (Siemens Medical Systems, Iselin, New Jersey). There were 57 caliceal stones, 167 in the renal pelvis, 31 in the proximal ureter, 16 in the mid ureter and 121 in the distal ureter, and 16 bladder stones.ResultsAll patients were treated on an outpatient basis, with intravenous sedation being used in 138 (40.1%), general anesthesia in 132 (38.4%) and no anesthesia in 74 (21.5%). A maximum of 3,500 shocks and 18 kV per session was given. A total of 780 SWL sessions were applied (mean 1.9 sessions per stone). Overall, a stone-free rate of 79.9% and clinically insignificant residual fragments in 13.2% of cases were observed at 3-month followup with a re-treatment rate of 53.9%. Overall efficacy quotient was 50.9%. Significantly more favorable results were achieved in ureteral calculi and stones 2 cm or smaller (p <0.05). Complications were observed in 33 patients (9.6%).ConclusionsOur results indicate that SWL, with satisfactory stone-free rates and efficacy quotients in stones 2 cm or smaller can be offered as a first line treatment in children.