Urolithiasis bei Kindern – rationelle Diagnostik, Therapie und Metaphylaxe

Abstract

With a proportion of 1-5%, children constitute only a small number of all patients with urolithiasis. Nevertheless, pediatric stone disease is an important health care problem because of the high recurrence rate and the threat of progredient renal function impairment with consecutive loss of quality of life. Modern therapies, especially extracorporeal shock wave lithotripsy (ESWL), ureteroscopy (URS), and percutaneous nephrolithotomy (PCNL), have caused a revolution in the operative treatment spectrum. Open surgery is required for stone removal only rarely, such as for the simultaneous repair of urinary tract anomalies. The minimally invasive modalities of modern stone therapy - mainly ESWL as the treatment of first choice - have led to widespread disregard of stone metaphylaxis. The important principle that says an urinary stone is just a symptom and not the cause of the disease is often forgotten. So it must be noted that despite the high standard of care in Germany, not all problems regarding urinary stone disease are being resolved, particularly in childhood. This article presents the current knowledge of the most important aspects of stone therapy and the methods of treatment in children.

Flexible ureteroscopic lithotripsy for the treatment of upper urinary tract calculi in infants

“…The treatment of complications is also difficult due to the poor tolerance of the developing kidneys in infants. 4,5 Most infantile urolithiasis is secondary to metabolic disorders and usually has high recurrence rates, resulting in a need for repeated treatments. However, repeated PCNL procedures performed in the developing kidneys of infants might lead to an increase in the risk of long-term renal atrophy.…”