What is ESWL? Can be done in a child? What are its indications?
ESWL (Extracorporeal shock wave lithotripsy) is a recent advance
in treatment of stones. This is done by a special equipment, which
is very expensive and is based on bombarding the stone with high
frequency shocks. The pulverized stone is than passed in urine
as small pieces. More than one sitting may be needed for removal
of single stone. Each sitting costs approximately Rs 5000-6000.
In very small infants and children below 5 years of age, it is
not advised. Very small (less than 2cm) and very large (more than
8cm) stones can not be treated by ESWL. Calcium oxalate, Struvite
and uric acid stones are easy to fragment. Cystine stone are difficult
to treat with ESWL.
Q: Does alkalinizing the urine help in dissolving the stone? When
should it be done?
Alkali treatment is useful to dissolve crystals before stone formation
occurs. Citrate alkali therapy is useful to dissolve uric acid
or calcium oxalate crystals, for prevention of recurrence of stones
and should be started no sooner the diagnosis is made. Dissolution
of a stone may not be possible.
My child had sudden onset of pain, which he felt from the loin
to his penis. What to do?
When pain starts suddenly from loin to penis, it means that the
stone has moved and is trying to come out. At this time pain reliever
and antispasmodic medication is advised namely Ibuprofen and Dicyclomine.
Fresh Ultrasonography/ X-rays are needed to localize the stone.
Child may require hospitalization if pain is severe till the stone
is passed. IV fluids, IV NaHCO3 with furosemide can push the stone
Can modification in diet help to decrease formation of renal stones?
Depending on the composition of the stone, diet should be modified
e.g. uric acid stones due to high serum uric acid should be treated
with restriction of meat, dals and pulses; oxalate stones require
restriction of spinach and tomatoes which are rich in oxalates.
further details see "Diet
for renal Stones
Q: In a child with calcium stones, should milk be omitted from
In growing children, restriction of milk or dairy product to reduce
calcium in diet is not advisable because calcium and high class
milk proteins are required for growth and mineralisation of bones.
Tonics containing excess of calcium should be avoided.
How is a child with renal stones to be monitored?
Child with renal stones should be monitored regularly for symptoms
like pain, hematuria, urinary complaints like dysuria (pain while
passing urine), frequency, burning etc. Ultrasonography should
be done every 2-3 months to look at the progress of stone. Urine
is examined for hematuria (blood in urine), pyuria (pus in urine)
and if required urine culture for UTI should be done till the
stone is passed or removed.
Q: What is the prognosis of a child with renal stones?
Prognosis is good if the stone is single and isolated. But recurrent
stones, which obstruct the urinary passage and are associated
with recurrent calculi and recurrent UTI can progress to CRF.
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updated on 04-04-2001