141 JOURNAL OF ENDOUROLOGY Volume 21, Number 2, February 2007 © Mary Ann Liebert, Inc. DOI: 10.1089/end.2006.0245 Pediatric Shockwave Lithotripsy: Size Matters! PANKAJ WADHWA, M.S., M.Ch., MONISH ARON, M.S., M.Ch., FRCS, AMLESH SETH, M.S., M.Ch., DNB, PREM N. DOGRA, M.S., M.Ch., ASHOK K. HEMAL, M.S., M.Ch., FICS, FACS, and NARMADA P. GUPTA, M.S., M.Ch., FAMS ABSTRACT Background and Purpose: Shockwave lithotripsy (SWL) is a safe and efficacious modality for pediatric urolithi- asis. Recent reports claim good results even with larger stone burdens, irrespective of stone location. We re- viewed the outcomes of SWL in the pediatric population at our center to assess the impact of stone burden and location and the age of the child on the stone-free rate. Patients and Methods: Records of 106 patients 16 years of age (mean age 10.9 years) treated with SWL for stones with a surface area of 20 to 600 mm 2 (mean 124.17 mm 2 ) from July 1989 to June 2004 were re- viewed. Metabolic abnormalities were present in 20.7% of the patients. All procedures were performed using the Siemens Lithostar, and stone clearance was assessed 3 months after SWL. Complications and the need for re-treatment and ancillary procedures were noted, and the impacts of stone size and location and the age of the child on stone clearance were assessed. Results: The overall stone-free rate was 87% (complete clearance 72%; insignificant [3-mm] residual frag- ments 15%). The re-treatment rate was 58%, and the efficiency quotient was 47. Whereas stone size corre- lated strongly with the stone-free rate (Mann-Whitney U test x  0.004; chi-square test P  0.02), patient age and stone location did not have a significant impact. Conclusions: Extracorporeal shockwave lithotripsy is an effective modality to treat pediatric upper urinary- tract calculi, especially when the stone burden is 200 mm 2 . Larger stone burdens are associated with poorer results, necessitate more ancillary procedures, and have a higher complication rate. INTRODUCTION U ROLITHIASIS IS UNCOMMON in the pediatric age group, with a reported incidence of 2% to 3% in the West- ern world. 1 Extracorporeal shockwave lithotripsy (SWL) has established its safety and efficacy in treating pediatric urolithi- asis. 2,3 Its ease of administration, short hospital stay, low com- plication rates, low morbidity, high safety profile, easier re- treatment, and acceptable success rates have established it as the first line of treatment for most pediatric renal stones. 4–6 Re- cent literature on pediatric upper-tract stones treated by SWL suggests efficacious clearance even of larger stone burdens. 7,8 We report an analysis of our results with SWL in patients un- der the age of 16 years treated over a 15-year period with the Siemens Lithostar lithotripter to assess the impact of stone size, stone location, and patient age on stone clearance. PATIENTS AND METHODS We reviewed the records of 106 patients 16 years of age (mean 10.9 years; range 3–16 years) with renal and upper- ureteral calculi treated with SWL at our center from July 1989 to June 2004. The male:female ratio was 2.2:1. The mean serum creatinine concentration was 0.9 mg/dL (range 0.4–2.9 mg/dL). Anatomic abnormalities were present in three patients, with one case each of horseshoe kidney, adult polycystic kidney disease, and vesicoureteral reflux. Four children had a solitary func- tioning kidney. A metabolic abnormality was found in 20.75% of the children, with renal hypercalciuria in 13 and hyperuri- cosuria in 9. Urinary-tract infection with a positive urine cul- ture was present in four children. Patients were evaluated by history, physical examination, and routine biochemical and microbiological tests. All patients Department of Urology, All India Institute of Medical Sciences, New Delhi, India.