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Sir,

Extracorporeal shockwave lithotripsy (SWL) is the most commonly used treatment for non-complex urinary calculi in adults. In pediatric patients, there were concerns about the possible harmful effects of ESWL on the parenchyma of growing kidneys. These concerns were assessed in animal models. Kaji et al. [1] reported histological changes in renal tubular and glomerular epithelium and interstitial cells in immature rabbits after SWL. These changes were thought to be the cause of an increase in arterial blood pressure among tested rabbits. However, SWL in that study was delivered directly to the renal parenchyma, which is different from clinical practice where SWL is delivered to the stones. Moreover, Kaji et al. [1] noticed no significant reduction in renal function or renal growth after SWL in immature rabbits.

On the other hand, clinical studies have proved that there are no significant long-term harmful effects of SWL on pediatric kidneys [2, 3] and SWL did not statistically affect linear growth (body height) or renal function in the pediatric population [4].

The concerns about the development of systemic diseases, e.g. hypertension and diabetes, were studied in adults with contradictory results. In pediatric patients, Lottmann et al. [2] and Frick et al. [3] found that SWL was not associated with increased incidence of hypertension. Our study proved the long-term safety of SWL for renal stones during childhood because there were no harmful effects on renal growth, linear growth or development of hypertension or diabetes [5].

The lesson learnt from these studies is that safe application of SWL in children requires adequate targeting, low energies and a limited number of shocks per session for sparing the renal parenchyma any possible deleterious effects [2]. Although SWL was considered to be the method of choice for managing renal stones in children of all ages [6], more studies with long-term follow-up are required to confirm the safety of SWL in pediatric patients.

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