Current management of paediatric urolithiasis

Abstract

We aimed to review a current management of paediatric nephrolithiasis. The current literature, including our own experience on the treatment of paediatric nephrolithiasis was reviewed by MEDLINE/PubMed search. We have used in our search following keywords: urolithiasis, nephrolithiasis, paediatrics, surgical treatment, conservative management, ESWL, ureteroscopy, and open renal surgery. The search was limited to the English language literature during the period of time from 1990 to 2011. All papers were reviewed independently by all co-authors and only the manuscripts directly related to the reviewed subjects were included into the current review. Due to the high incidence of predisposing factors for urolithiasis in children and high stone recurrence rates, every child with urinary stone should be given a complete metabolic evaluation. Most stones in children can be managed by ESWL and endoscopic techniques. Paediatric stone disease is an important clinical problem in paediatric urology practice. Because of its recurrent nature, every effort should be made to discover the underlying metabolic abnormality so that it can be treated appropriately. Obtaining a stone-free state with interventional management and close follow-up are of utmost importance.

Minimally invasive percutaneous nephrolithotomy: an effective treatment for kidney stones in infants under 1 year of age. A single-center experience

“…Older children often present with classical admission complaints, including flank pain and hematuria. However, infants are more often admitted with gastrointestinal symptoms, such as acute abdominal cramps, nausea, and vomiting, as well as nonspecific symptoms, such as restlessness [12,13]. Microscopic hematuria is frequently observed in the infantile age group.…”

“…PNL was performed in patients with renal stones larger than 2 cm, as well as stones resistant to SWL or renal stones that were undetectable during SWL. The mean age of the patients was 9.55 (5)(6)(7)(8)(9)(10)(11)(12) months. Of the 20 renal units, 1 had complete staghorn stones, 3 had partial staghorn stones, 13 had renal pelvic stones, and 3 had lower pole stones.…”

A 24 h urine collection is essential in nephrolithiasis evaluation

“…3,5 The same studies show that uric acid is present in only 2-3% of stones in paedi atric patients, whereas uric acid is present in 11% of kidney stones in adults. Why do younger patients form more calcium-based stones and fewer uric acid stones?…”

“…4 Predisposing factors can be identified in up to 87% of children with urolithiasis; recurrent stone disease occurs in 67% of paediatric patients. 3,4 For these reasons, all children who are found to have nephrolithiasis should have a complete evaluation of potential risk factors. The goals of the metabolic evaluation are to identify children who are at increased risk for recurrent stone disease and to diagnose specific treatable metabolic derangements.…”

“…1,2 Although kidney stones are relatively rare in children, recent data regarding incidence, cost and hospitalization rates high light the need for a better understanding of the metabolic underpinnings of, as well as environmental contributors to, paediatric nephrolithiasis so that we can improve on strategies for prevention. [2][3][4][5] Similar to many other nephrologic conditions, there is a paucity of data in children compared with adults regarding nephrolithiasis. Furthermore, no clinical recommendations on testing are available for paedi atric stone formers in the USA.…”