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11–14 APRIL, 2018, HELSINKI, FINLAND
12:04–12:07
S24-5 (PP)
FATE OF RESIDUAL STONE FRAGMENTS IN CHILDREN:
IS THERE ANY CUT-OFF BETWEEN SIGNIFICANT
AND INSIGNIFICANT
Sadaf ABA UMER KODWAVWALA, Bashir AHMED, Sajid SULTAN and Adeeb Ul
Hasan RIZVI
Sindh Institute of Urology & Transplantation, Philip G. Ransley Department of Paediatric Urology, Karachi, PAKISTAN
PURPOSE
To determine the outcome of residual stone fragments (RF) post ESWL,in terms of stone passage/
disappearance,stone regrowth,static size,symptoms/interventions required.
MATERIAL AND METHODS
Retrospective review of prospectively collected data of 102 Renal Units (RU) who underwent ESWL
between 2012–2016 and had RF upto 6 mm (on USG +/- plain xray KUB), three months after last
session. Statistical analysis was done on SPSS v.20 by using chi-square test.
RESULTS
Of the 102,8 were lost to follow up,leaving 94 RU with RF upto 6 mm. Median follow-up of
17 months(6–55 mon). Mean age was 6.6+/-3.8 years with M:F,2.1:1. In 82 %, RF were located
in lower calyces. Ninty-one percent received metaphylaxis. RU were divided into 4 groups: Group
I. <=3 mm(n=22), Group II. 4 mm (n=18), Group III. 5 mm(n=28) and Group IV. 6 mm (n=26). RF
disappear in 31/94(33 %),of which 35.5 % were in Group I and 12.9 % in Group IV (p=0.06). Re-
growth was observed in 11/94 (11.7 %),of which 54 % were in Group IV (p=0.07). In 40 % RF
remained static in size (p=0.45). Seven units(7.4 %)needed intervention for stone migrated into the
ureter (alpha blocker=2, Ureterorenoscopy=5).
Outcome parameters were compared to determine cut-off between significant and insignificant RF
but no such cut-off size found on which all parameters become significant. However when RF
<=5 mm were compared with 6 mm, stone disappearance was significantly more in 5 mm RF group
(p=0.02) whereas stone regrowth was significantly higher in 6 mm group (p=0.03) but this was not
enough for cut-off size, as fragment <=5 mm required intervention in 7.4 % as compared to 7.7 %
in 6 mm (p=0.9).
CONCLUSIONS
Patients with RF of any size after ESWL require close follow up and timely intervention if needed.
As the fragment size increases from 5 to 6 mm, chances of stone regrowth increase and clearance
decrease. However RF of >3 mm can become symptomatic or require intervention any time during
follow up, therefore it is difficult to draw any cut off between significant and insignificant RF in
children.
12:07–12:16
Discussion