Management of stone disease in infants

Abstract

Evaluating and treating renal stone disease in infants are technically challenging. In this study, we evaluated the surgical treatment of renal stones in children under 1 year of age. We retrospectively reviewed the records of patients under 1 year old who were treated with ESWL, endourological or open surgical procedures for renal stone disease between January, 2009 and December, 2012. The patients' age, gender, stone size, stone location and number, complications, stone-free status, and postoperative complications were recorded. 19 of 121 infants with a mean age of 10.2 ± 3.07 months were treated with surgical procedures. Six (75%) of eight cystinuria patients required a surgical intervention. Retrograde endoscopic management was performed in thirteen patients (63.4%) as an initial surgical approach. There were three major (15.7%) complications. The rate of open surgical procedures was 31.6% (6 of 19 infants). The cutoff value of stone size for open surgery was 10 mm. There was a significant relationship between the conversion to open procedures and stone size, stone location, and symptom presentation especially the presence of obstruction (p < 0.05). After repeated treatments, the stone clearance rate of RIRS reached 84.6%. Retrograde intrarenal surgery is an effective and safe treatment method for renal stones in infants and can be used as a first-line therapy in most patients under 1 year old. This is especially important if an associated ureteral stone or lower pole stone that requires treatment is present and for patients with cystinuria, which does not respond favorably to ESWL.

Pediatric Nephrolithiasis: Trend, Evaluation and Management: A Systematic Review

“…Besides, medical expulsive therapy such as alphablocker (tamsulosin, terazosin) or calcium channel blockers (nifedipine) may facilitate the passage of small stones by relaxing ureteral smooth muscle. Actually, tamsulosin is wildly prescribed for pediatric nephrolithiasis (59)(60)(61)(62). The stone passage may take more than one month and in this period, the patients need appropriate care and followup.…”

Percutaneous nephrolithotomy and ureteroscopy procedures in children

“…Açık operasyona dönülen hastaların 5 yaş altında ve sistin taşlı olgular olduğu görül-mektedir (12) . Klinik deneyimimizin geliştiği sonraki yıllarda üreter taşlarında açık operasyona dönüşümüz olmadığı gibi, URS ve RIRS girişimlerini bir yaş altındaki hastalarımızda bile başarı ile uygulanabildiği-ni görmekteyiz (10,11) . Çocuklardaki RIRS uygulamalarında yineleyen girişimlerin taşsızlığı sağlamak için gerekeceği akılda tutulmalıdır.…”

“…Vü-cut dışı şok dalgaları ile üriner sistem taşlarının kırı-labilmesi tedavide devrim yaratmışsa da bazı taşların şok dalgaları ile kırılamaması, çocuklarda işlemin uygulanması için genel anestezi gerekmesi, 15 mm'den büyük taşlarda ve özellikle böbrek alt pol taşlarında başarının düşük olması farklı tedavi girişimlerinin gündeme gelmesine neden olmuştur (5)(6)(7)(8) . Özellikle son 20 yılda gelişen endoskop ve görüntüleme sistemleri sayesinde erişkinlerde rutin hâle gelen bazı uygulamalar çocuklarda da yaygın olarak kullanılma-ya başlanmıştır (9)(10)(11)(12) . Üreteroskopi (URS) ve perkutan nefrolitotomi (PNL) uygulamaları günümüzde çocuk üriner sistem taşlarının tedavi seçenekleri içerisinde kılavuzlara girerek rutin uygulamada yer almaktadır (13) .…”

Clinical efficacy of percutaneous nephrolithotomy versus retrograde intrarenal surgery for pediatric kidney urolithiasis

“…It has been reported that PCNL is more efficacious and less invasive, and is associated with less blood loss than open surgery, which was said to be performed more often in pediatric patients. [ 4 , 5 ] For larger kidney stones (greater than 20 mm), PCNL has been recommended as the first-line treatment in adults. [ 6 ] At the same time, the development of smaller endoscopes for stone disintegration has resulted in ureteroscopy being more frequently used to treat kidney stones in children.…”