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Slavkovic, Andjelka; Radovanovic, M.; Širić, Zlatko; Vlajković, Marina; Stefanovic, V.

doi:10.1023/a:1025694230131

Cited by 31 publications

(6 citation statements)

References 11 publications

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“…Although stone-free rates were low, fragmentation was achieved in 100% of patients and the stone dissolution was achieved with medical therapy in the remaining children following SWL. [28] Authors have proposed that cystine stones formed within two years of therapy may be more easily fragmented with SWL and that stone number and not diameter may be more predictive of success. [21]…”

Section: Shock Wave Lithotripsymentioning

confidence: 99%

The evolution of the endourologic management of pediatric stone disease

2009

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In the 1980s, the advent of shock wave lithotripsy (SWL) revolutionized pediatric stone management and is currently the procedure of choice in treating most upper tract calculi <1.5 cm in children. However, with miniaturization of instruments and refinement of surgical technique the management of pediatric stone disease has undergone a dramatic evolution over the past twenty years. In a growing number of centers, ureteroscopy (URS) is now being performed in cases that previously would have been treated with SWL or percutaneous nephrolithotomy (PCNL). PCNL has replaced open surgical techniques for the treatment of large stone burdens >2 cm with efficacy and complication rates similar to the adult population. Recent results of retrospective reviews of large single institution series demonstrate stone free and complication rates with URS comparable to PCNL and SWL but concerns remain with these techniques regarding renal development and damage to the pediatric urinary tract. Randomized controlled trials comparing the efficacy of SWL and URS for upper tract stone burden are needed to reach consensus regarding the most effective primary treatment modality in children. This report provides a comprehensive review of the literature evaluating the indications, techniques, complications, and efficacy of endourologic stone management in children.

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Section: Shock Wave Lithotripsymentioning

confidence: 99%

The evolution of the endourologic management of pediatric stone disease

2009

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“…The mean stone burden was 2,533 (171-9,202) mm 3 in group 1 and 5,791 (696-17,157) mm 3 in group 2 (p = 0.02). The first urological procedure was performed at a mean age of 17 (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23) months in group 1 and 8.6 (3-13) years in group 2.…”

Section: Resultsmentioning

confidence: 99%

“…Urological management for cystine stones is challenging. Some authors suggest that ESWL should be restricted to stones smaller than 15 to 25 mm (longest diameter) and prefer PCNL or ON for larger stones (3,(23)(24)(25). RUS is preferred for distal ureteral stones (26,27) and represent a suitable alternative when treating fragments refractory to prior ESWL (3,14,28) but remains difficult in young patients.…”

Section: Discussionmentioning

confidence: 99%

Extracorporeal Shockwave Lithotripsy for Cystine Stones in Children: An Observational, Retrospective, Single-Center Analysis

Vinit¹,

Khoury²,

Lopez³

et al. 2021

Front. Pediatr.

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Purpose: Cystinuria is a genetic disorder characterized by a defective reabsorption of cystine and dibasic amino acids leading to development of urinary tract calculi from childhood onward. Cystine lithiasis is known to be resistant to fragmentation. The aim was to evaluate our long-term experience with extracorporeal shockwave lithotripsy (ESWL) used as first-line urological treatment to treat cystine stones in children.Methods: We retrospectively reviewed the charts of all children who underwent ESWL for cystine stone. We assessed the 3-month stone-free rate, according to age, younger (group 1) or older (group 2) than 2 years old.Results: Between 2003 and 2016, 15 patients with a median (IQR) age at first treatment of 48 (15–108) months underwent ESWL in monotherapy. Median age was, respectively, 15 and 108 months in each group. The median (IQR) stone burden was 2,620 (1,202–8,265) mm3 in group I and 4,588 (2,039–5,427) mm3 in group II (p = 0.96). Eleven patients had bilateral calculi. ESWL was repeated on average 2.4 times, with a maximum of 4 for patients of group I, and 4.8 times, with a maximum of 9 for group II (p > 0.05). ESWL in monotherapy was significantly more efficient to reach stone-free status for children under 2 years of age: 83% vs. 6.2% (p = 0.040). The median (IQR) follow-up of the study was 69 (42–111) months.Conclusion: ESWL appears as a valid urological option for the treatment of cystine stones, in young children. Even if cystine stones are known to be resistant to fragmentation, we report 83% of stone-free status at 3 months with ESWL used in monotherapy in children under 2 years old with cystinuria. In older children, the success rate is too low to recommend ESWL as a first line approach.

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“…In a study of 29 adult cystinuria patients treated with high fluid intake and alkalinization, Barbey et al [20]calculated that about 1 new stone is formed per patient-year and each patient has an average of one surgical procedure every 3 years. By middle age, the average cystinuria patient can expect to have undergone about 7 surgical procedures for nephrolithiasis [21]. Acute obstruction of the urinary tract by a cystine stone may be relatively asymptomatic yet produce rapid loss of renal parenchyma [22].…”

Section: Cystine Nephrolithiasismentioning

confidence: 99%

“…Furthermore, the eventual risk of reduced GFR correlates with the number of such interventions [30]. Extracorporeal shockwave lithotripsy (ESWL) may require general anesthesia in small children; ESWL success is reasonable in older children with pelvic and ureteral stones, but is poor for calyceal stones [21]. …”

Section: Conservative Therapy Of Cystinuriamentioning

confidence: 99%

The Molecular Basis of Cystinuria

Goodyer¹

2004

Nephron Exp Nephrol

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Cystinuria is an inherited form of nephrolithiasis due to failure of reabsorptive transport in the proximal tubule. Patients with classical recessive cystinuria have inherited two mutations of the SLC3A1 gene, encoding a subunit of the transport mechanism. Patients with the dominant form of cystinuria have inherited two mutations of the SLC7A9 gene, encoding the transport channel itself. A smaller subset of patients have mixed-type cystinuria, combining recessive and dominant mutant alleles. Children at risk for nephrolithiasis can be identified by the level of urinary cystine only after tubular transport has matured (age 2 years). Conservative therapy with high urine volume and urinary alkalinization is sufficient for some, but recurrent stone formation may cause renal damage and warrants prophylaxis with agents that form mixed disulfides with cystine.

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Untitled

Cited by 31 publications

References 11 publications

The evolution of the endourologic management of pediatric stone disease

The evolution of the endourologic management of pediatric stone disease

Extracorporeal Shockwave Lithotripsy for Cystine Stones in Children: An Observational, Retrospective, Single-Center Analysis

The Molecular Basis of Cystinuria

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