Abstract: Since its introduction in 1980, extracorporeal shockwave lithotripsy (SWL) has become the first therapeutic option in most cases of upper-tract urolithiasis, and the technique has been used for pediatric renal stones since the first report of success in 1986. Lithotripter effectiveness depends on the power expressed at the focal point. Closely correlated with the power is the pain produced by the shockwaves. By reducing the dimensions of the focus, it becomes possible to treat the patient without anesthesia or analgesia but at the cost of a higher re-treatment rate. Older children often tolerate SWL under intravenous sedation, and minimal anesthesia is applicable for most patients treated with second- and third-generation lithotripters. Ureteral stenting before SWL has been controversial. Current data suggest that preoperative stent placement should be reserved for a few specific cases. Stone-free rates in pediatric SWL exceed 70% at 3 months, with the rate reaching 100% in many series. Even the low-birth-weight infant can be treated with a stone-free as high as 100%. How can one explain the good results? Possible explanations include the lesser length of the child's ureter, which partially compensates for the narrower lumen. Moreover, the pediatric ureter is more elastic and distensible, which facilitates passage of stone fragments and prevents impaction. Another factor is shockwave reproduction in the body: there is a 10% to 20% damping of shockwave energy as it travels through 6 cm of body tissue, so the small body volume of the child allows the shockwaves to be transmitted with little loss of energy. There are several concerns regarding the possible detrimental effect of shockwaves on growing kidneys. Various renal injures have been documented with all type of lithotripters. On the other hand, several studies have not shown adverse effects. In general, SWL is considered to be the method of choice for managing the majority of urinary stones in children of all ages. Re-treatments improve the stone-free rate, often raising it to 100%. Among the predictors of success, stone size seems to be the most important. In the absence of guidelines, selecting the appropriate treatment modality for each child requires planning and depends on instrument availability and local expertise.
Abstract: Removal of urinary calculi is an essential element in the successful treatment of patients with urinary stone disease. The new generation of lithotriptors allows the treatment without the need for general anesthesia. The patients, often outpatients, have a faster discharge from the hospital with a reduction of hospitalization time and operating costs. Shock wave lithotripsy (SWL) is currently considered a safe technique for treatment of pediatric urinary lithiasias, with a low percentage of complications and subsequent surgical retreatments. But can we define SWL as a safe procedure in pediatrics? Herein, we will review the literature to justify SWL safety in children, focusing on important parameters as the insertion of preoperative stenting, side effects, and complications after the procedure.
Abstract: Ureteral endometriosis is a rare localization of gynecological disease. We presented a case of left ureteral endometriosis in a 30-year-old woman with left abdominal pain and a radiological nonfunctioning kidney. Surgical treatment with ureteral resection and uretero-uretero anastomosys was conducted. Pathological examination of surgical specimen revealed endometriosis. The diagnosis of ureteral endometriosis should be considered in women with renal symptoms of noncalculous obstruction, particularly in premenopausal women with an anamnesys of polycistic ovary disease (POD) or severe menstrual related symptoms, although the disease is often strictly associated with silent renal obstruction. Only a high index of suspicion and the radiological support may help the urologist to obtain a early diagnosis. Early detection and prompt treatment strategy, surgical too, are extremely important to relieve symptoms and preserve renal function. The literature was reviewed.
