SHOCK WAVE LITHOTRIPSY IN PREPUBERTAL CHILDREN1840

EDITORIAL COMMENT

This study confirms many points. 1) ESWL mono-therapy is effective in children with an 80% 3SFRafter 1 session and 97% after up to 3. 2) The highestsuccess rate of 84% is achieved in the infant sub-group. 3) Morbidity is extremely low and not specificto the technique. 4) Cystine stones are difficult tofragment. 5) Ureteroscopy is a valid alternative toESWL. If the ureteroscope cannot be introduced intothe ureter, instead of inserting a Double-J® stent inview of a secondary attempt, we suggest treating thepatient with ESWL under the same anesthesia. 6)

REPLY BY AUTHORS

ergy source and flexibility, intracorporeal lithotripsy may

circumcised boys with struvite or calcium phosphatecalculi, which are particularly easy to fragment andeliminate (even large stones), without preventiveureteral stenting, particularly in infants (references3 and 21 in article). Irradiation is another issue andwe suggest ultrasound rather than fluoroscopy totarget the stone.

H. B. Lottmann

Société de chirurgie viscérale pédiatriqueHôpital Necker-Enfants Malades

Paris Cedex 15

Stone composition is relevant. We mainly treat un- France

Our unique experience has been gathered using theHM3 lithotriptor, which has had superior results over allsecond and third generation machines. As ureteroscopesand nephroscopes continue to improve in size, sight, en-

replace extracorporeal lithotripsy. To keep up with tech-nological improvements lithotriptors must also be im-proved in targeting, imaging and reducing or avoidingpain. We believe that such improvements are possible,

provided substantial research is performed.