Russian Journal of Pediatric SurgeryRussian Journal of Pediatric SurgeryДетская хирургия1560-95102412-0677Eco-Vector76210.17816/ps762ReviewsОБЗОРЫReview ArticleFactors and nomograms determining the effectiveness of extracorporeal shock wave lithotripsy in children with urolithiasis: a literature reviewФакторы и номограммы, определяющие эффективность дистанционной ударно-волновой литотрипсии в лечении мочекаменной болезни у детей: обзор литературыhttps://orcid.org/0000-0001-7971-50732665-2856LobanovaAntonina D.ЛобановаАнтонина Денисовна
Russian Federation

MD

lobanova.ad@nczd.ruhttps://orcid.org/0000-0002-2731-50084762-8837ZorkinSergey N.ЗоркинСергей Николаевич
Russian Federation

MD, Dr. Sci. (Medicine), Professor

д-р мед. наук, профессор

zorkin@nczd.ruNational Medical Research Center for Children's HealthНациональный медицинский исследовательский центр здоровья детей08062024130720242832842910711202328022024Copyright ©; 2024, Eco-VectorCopyright ©; 2024, Эко-Вектор2024Eco-VectorЭко-Векторhttps://creativecommons.org/licenses/by-nc-nd/4.0/https://jps-nmp.ru/jour/article/view/762

Extracorporeal shock wave lithotripsy (ESWL) is currently the priority method for treating urolithiasis in children. Due to the lack of extended indications for the application of this technique, an active search has been made over the past 30 years to define factors predicting ESWL outcome, to create objective preoperative planning tools, to increase ESWL effectiveness and to reduce the number of anesthetics and unnecessary surgical interventions.

Search for the information on predictive factors of ESWL successful intervention and on modern statistical tools predicting lithotripsy effectiveness in children with urolithiasis was made in foreign and domestic sources, like MEDLINE, eLIBRARY, CyberLeninka.

The literature analysis has showed that the following factors predispose positive ESWL outcomes: age before six years, smaller calculi size, and shorter skin-to-stone distance. Stone location in the lower calyx group, multiple concrements, and their high density has a negative impact at complete fragment detachment after ESWL. The probability of complete detachment of stone fragments from the lower calyx group decreases under the following anatomic features of kidney collecting system: number of draining calyces is more than one, calyx neck diameter is less than 4 mm, acute angle between the lower infundibulum and renal pelvis. Body mass index and prestenting have a controversial effect at successful ESWL too.

Nomograms and scoring systems based on predicting factors are widely used in both adult and pediatric practice. The two most commonly used nomograms in pediatric urology are Onal and Dogan nomograms developed in 2012 and 2015 in Turkey. These nomograms include the following parameters: patient's sex and age, history of ipsilateral surgical interventions as well as stone localization, number and size.

Thus, predicting ESWL outcomes using preoperative planning allows to choose the most appropriate treatment modality for a particular patient considering his/her individual anatomical and physiological characteristics and characteristics of the calculi.

Дистанционная ударно-волновая литотрипсия (ДУВЛ) в настоящее время является методом выбора при лечении мочекаменной болезни у детей. Ввиду отсутствия расширенных показаний к применению данного метода, на протяжении последних 30 лет ведутся активные поиски факторов, предсказывающих исход ДУВЛ, для создания объективных инструментов предоперационного планирования, увеличения эффективности ДУВЛ, снижения числа анестезиологических пособий и лишних хирургических вмешательств.

Поиск информации о факторах предикции успешности сеанса ДУВЛ и существующих на сегодня статистических моделях предсказания эффективности литотрипсии у детей с уролитиазом проводился по зарубежным и отечественным базам данных медицинских исследований: MEDLINE, eLIBRARY, КиберЛенинка.

Анализ данных литературы показал, что положительно на эффективность ДУВЛ влияют возраст пациентов до 6 лет, меньший размер конкремента и меньшее расстояние от кожи до камня. Отрицательно на полное отхождение осколков конкрементов после проведения сеанса ДУВЛ влияет локализация камня в нижней группе чашечек, множественность конкрементов, их высокая плотность. Вероятность полного отхождения фрагментов конкремента из нижней группы чашечек уменьшается при следующих особенностях анатомии собирательной системы почки: число дренирующих чашечек более одной, диаметр шейки чашечки <4 мм, острый шеечно-лоханочный угол. Спорное влияние на успешность дистанционной литотрипсии оказывает индекс массы тела и проведение престентирования.

Номограммы и балльные системы, созданные на основе факторов предикции, широко применяются как во взрослой, так и в детской практике. Двумя наиболее распространёнными номограммами в детской урологии являются номограммы Онала и Догана, разработанные в 2012 и 2015 гг. в Турции. В основу данных номограмм легли следующие параметры: пол и возраст пациента, анамнез ипсилатеральных оперативных вмешательств, локализация, число и размер конкрементов.

Таким образом, возможность предсказать исход сеанса ДУВЛ с помощью инструментов предоперационного планирования позволяет подобрать наиболее подходящий метод лечения для конкретного пациента с учётом его индивидуальных анатомо-физиологических особенностей и характеристик конкремента.

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