Predictive Factors and Management of Steinstrasse After Shock Wave Lithotripsy in Pediatric Urolithiasis—A Multivariate Analysis Study

• Published in: Urology (Ridgewood, N.J.) N.J.), 2012-11, Vol.80 (5), p.1127-1131
• Main Authors: Onal, Bulent, Citgez, Sinharib, Tansu, Nejat, Demirdag, Cetin, Dogan, Cagatay, Gonul, Burcu, Demirkesen, Oktay, Obek, Can, Erozenci, Ahmet
• Format: Article
• Language: English
• Subjects: Adolescent; Biological and medical sciences; Child; Child, Preschool; Female; Follow-Up Studies; Humans; Incidence; Infant; Lithotripsy - adverse effects; Male; Medical sciences; Multivariate Analysis; Nephrology. Urinary tract diseases; Retrospective Studies; Risk Factors; Sex Distribution; Time Factors; Treatment Outcome; Turkey - epidemiology; Ureteral Obstruction - epidemiology; Ureteral Obstruction - etiology; Urinary lithiasis; Urolithiasis - therapy; Urology
• ISSN: 0090-4295; 1527-9995
• DOI: 10.1016/j.urology.2012.06.043

Objective To define the predictive factors for the formation of steinstrasse (SS) after shock wave lithotripsy (SWL) and determine the treatment strategies for this complication in pediatric urolithiasis. Methods We retrospectively reviewed the data of 341 renal units (RUs) treated with SWL for urolithiasis. The stone location, stone burden, auxiliary procedures, energy level, and number of shock waves were recorded. Statistical analysis was performed to detect the predictive factors for the formation of SS. In addition, the treatment of children with SS was evaluated. Results The mean age of the children was 8.31 years (range 1-17). Episodes of SS developed in 26 RUs (7.6%). Of the 26 RUs, 20 (77%) were localized in the lower, 5 (19%) in the upper, and 1 (4%) in multiple locations in the ureter. The stone burden was the only statistically significant factor predicting the formation of SS on logistic regression analysis ( P = .001). Of the 26 RUs, 17 (65.4%) were successfully managed by repeat SWL monotherapy, 4 (15.4%) were managed with ureteroscopy after failure of SWL, 1 (3.8%) was managed by ureteroscopy monotherapy, and 4 (15.4%) were monitored with conservative management with antispasmodic drug plus hydration therapy. The mean number of SWL sessions was 1.72. Conclusion The incidence of SS development in children after SWL treatment was similar to that in adult series. Our results suggest that the stone burden is a significant predictive factor for the development of SS after SWL in pediatric urolithiasis. Most children with SS could be easily and safely treated by repeat SWL.