Abstract Book - 26th ESPU Congress, Joint Meeting with ICCS + SPU + AAP/SOU + AAPU + SFU

13:58 - 14:01

S9-3

(PP)

★

POSTURAL THERAPY FOR RENAL STONES IN CHILDREN: A ROLLING STONES

PROCEDURE

Alice FAURE

, Geraldine HERY

, Nicoleta PANAIT

, Eugenie DICROCCO

, Pierre ALESSANDRINI

, Thierry MERROT

and

Jean-Michel GUYS

1) Aix-Marseille university-APHM, Paediatric Urology Department, Marseille, FRANCE - 2) Aix-Marseille University-APHM,

Pediatric surgery department, Marseille, FRANCE - 3) Aix-Marseille University-APHM, Urology Department, Marseille,

FRANCE

PURPOSE

Despite many advances, the management of lower caliceal stones (LCS) remains a challenge. The gravity-dependant

location of the lower calixes hinders the spontaneous clearance of fragments that can be the nidus for future growth and

symptomatic recurrence. We report our preliminary experience and effectiveness of mechanical percussion diuresis and

inversion (PDI) therapy for eliminating LCS.

MATERIAL AND METHODS

Since November 2013, children with residual fragments (after SWL or URS) or native symptomatic LCS were

prospectively include into a protocol of 4 PDI sessions. After informed consent, according to the local ethic committee,

children drank 500ml of water 1h before therapy. They then laid in a prone Trendelembourg position on a 45°-angle

couch, and received continuous 10-minute mechanical percussion applied over the affected flank by a physiotherapist.

Tolerance and stone clearance were documented with ultrasound 4-weeks following PDI.

RESULTS

Seventy-two PDI sessions were performed in 14 candidates at a mean age of 11.6 years (18m-18y) in 16 months.

Median stone diameter was 5.4mm (3-9). Four children had bilateral stones. Nine children (64%) who experienced

symptomatic episodes required PDI as the first step of management. The overall stone-free rate was 66%. Three of the

5 patients who previously underwent SWL/URS passed fragments. Patients who did not become stone-free by PDI had a

decrease in stone-area of 56% (95%IC 34%-69%). No significant adverse effects were noted. Observance rate was

100%.

CONCLUSIONS

PDI is safe and effective for facilitating gravity-dependant drainage of LCS. PDI provides an opportunity to treat children

in a quick, non-invasive, painless, non-radiative and diverting fashion. This therapy is a valuable alternative in the

pattern of stone management.