Management of Ureteral Stones in Pediatric Patients

Delakas, Dimitrios; Daskalopoulos, George; Metaxari, Maria; Triantafyllou, Theodosis; Cranidis, Angelos

doi:10.1089/08927790152596226

Cited by 22 publications

(21 citation statements)

References 26 publications

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“…Because of its low morbidity, SWL is the method of choice for all patients with a cystine stone within the upper urinary tract with a maximal diameter up to 1.5 cm [49,50,51,52]. Although cystine stones respond less well to SWL than calcium stones, the stone-free rate after SWL, even for large cystine stones, is significantly higher in children than in adults with stones of matching size [53,54].…”

Section: Shock Wave Lithotripsymentioning

confidence: 99%

“…In patients with primary lower caliceal stones, new thin flexible ureterorenoscopes may improve the outcome. Furthermore, URS offers a good treatment for fragments refractory to prior SWL treatment [52]. The maximal stone size is comparable to SWL (1.5-2 cm) and depends on available scopes, instruments, and lithotripsy probes [43].…”

Section: Ureteroscopymentioning

confidence: 99%

“…In recent years, there has been an increased use of holmium lasers, which are highly efficient for lithotripsy of stones of all compositions and are thin enough even to be used in small flexible uterorenoscopes [57,58]. When URS is performed in experienced centers, major complications such as ureter perforation or avulsion are rare [52,55]. However, retrograde or antegrade ureteroscopy must be performed judiciously to minimize ureteric injury in children.…”

Section: Ureteroscopymentioning

confidence: 99%

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Cystinuria in childhood and adolescence: recommendations for diagnosis, treatment, and follow-up

et al. 2004

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Cystinuria, an autosomal-recessive disorder of a renal tubular amino acid transporter, is the cause of about 10% of all kidney stones observed in children. Different genetic characteristics are not represented by different phenotypes. The stones are formed of cystine, which is relatively insoluble at the physiological pH of urine. Without any preventive measures, the patients will suffer from recurrent stone formation throughout their life. Even with medical management, long-term outcome is poor due to insufficient efficacy and low patient compliance. Many patients suffer from renal insufficiency as a result of recurrent stone formation and repeated interventions. However, regular follow-up and optimal pharmacotherapy significantly increase stone-free intervals. Medical management is mainly based on hyperhydration and urine alkalinization. Sulfhydryl agents such as tiopronin can be added. Recurrent stone formation necessitates repeated urological interventions. These mostly minimally invasive procedures carry the risk of impairment of renal function. In adults, extracorporeal shockwave lithotripsy (SWL) as well as intracorporeal lithotripsy is often unsuccessful. However, in children SWL shows excellent results for cystine stones. In cases with large stone burden, percutaneous nephrolithotripsy (PNL) or even open surgical nephrolithotomy are preferred. This review discusses the underlying pathogenetic mechanisms and provides guidance for the diagnosis, therapy, and management of cystinuria following the recommendations of the International Cystinuria Consortium and the European Association of Urology.

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Section: Shock Wave Lithotripsymentioning

confidence: 99%

Section: Ureteroscopymentioning

confidence: 99%

Section: Ureteroscopymentioning

confidence: 99%

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Cystinuria in childhood and adolescence: recommendations for diagnosis, treatment, and follow-up

et al. 2004

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“…Generally, treatment options of pediatric lithiasis and trends are similar to those of adult lithiasis. In fact, stone size and location are important factors-together with symptom severity, degree of obstruction, presence or absence of infection and level of renal function-in deciding whether to manage the stone initially by observation, awaiting spontaneous passage, or to actively intervene (4). Despite the smaller diameter of the child's ureter, the cut-of volume of 4 mm seems to be adequate to decide upon active intervention (5).…”

Section: Commentsmentioning

confidence: 99%

Extracorporeal shock wave lithotripsy in the treatment of pediatric urolithiasis: a single institution experience

et al. 2010

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Purpose: To compare the efficacy and safety of the electromagnetic lithotripter in the treatment of pediatric lithiasis to that of the earlier electrohydraulic model. Results: In the first group, 21/26 children (80.7%) were stone free at first ESWL session. Colic pain resolved by administration of an oral analgesic in 6 (23%), brief hematuria (< 24 h) resolved with increased fluid intake in 5 (19.2%), while slightly elevated body temperature (< 38°C) occurred in 4 (15.3%). Four children (15.3%) failed to respond to treatment and were treated with ureteroscopy. In the second group 18/19 children were completely stone free at first ESWL session (94.7%). Complications were infrequent and of minor importance: colic pain treated with oral analgesic occurred in 1 (5.26%), brief hematuria (< 24 h), resolved with increased fluid intake in 4 (21%) and slightly elevated body temperature (< 38°C) monitored for 48 hours occurred in 6 (31.5%). Statistical analysis showed that electromagnetic lithotripter is more efficacious and safer than the earlier electrohydraulic model. Conclusions: Technological development not only has increased efficacy and safety of lithotripter devices in treating pediatric lithiasis, but it also provided less painful lithotripsy by eliminating the need for general anesthesia.

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“…In fact, most will pass stones spontaneously, with or without adjunctive pharmacological therapy, and have no lasting sequelae. 5–7 However, surgical intervention is needed in approximately 20% to 25% of patients. 2,3 …”

mentioning

confidence: 99%

Outcomes of Shock Wave Lithotripsy and Ureteroscopy for Treatment of Pediatric Urolithiasis

et al. 2016

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Purpose: Shock wave lithotripsy has been commonly used to treat children with renal and ureteral calculi but recently ureteroscopy has been used more frequently. We examined postoperative outcomes from these 2 modalities in children. Materials and Methods: We reviewed linked inpatient, ambulatory surgery and emergency department data from 2007 to 2010 for 5 states to identify pediatric admissions for renal/ureteral calculi treated with shock wave lithotripsy or ureteroscopy. Unplanned readmissions, additional procedures and emergency room visits were extracted. Multivariate logistic regression using generalized estimating equations to adjust for hospital level clustering was performed. Results: We identified 2,281 admissions (1,087 for shock wave lithotripsy and 1,194 for ureteroscopy). Ages of patients undergoing ureteroscopy and those undergoing shock wave lithotripsy were similar (median 17.0 years for both cohorts, p = 0.001) but patients were more likely to be female (63.4% vs 54.7%, p <0.0001), to be privately insured (69.8% vs 62.2%, p <0.0005) and to have a ureteral stone (81.0% vs 34.8%, p <0.0001). Patients undergoing ureteroscopy demonstrated a lower rate of additional stone related procedures within 12 months (13.6% vs 18.8%, p <0.0007) but a higher rate of readmissions (10.8% vs 6.3%, p <0.0002) and emergency room visits (7.9% vs 4.9%, p <0.0036) within 30 days postoperatively. On multivariable analysis patients undergoing ureteroscopy were nearly twice as likely to visit an emergency room within 30 days of the procedure (OR 1.97, p <0.001) and to be readmitted to inpatient services (OR 1.71, p <0.01). Conclusions: Ureteroscopy is now used more commonly than shock wave lithotripsy for initial pediatric stone intervention. Although repeat treatment rates did not differ between procedures, ureteroscopy patients were more likely to be seen at an emergency room or hospitalized within 30 days of the initial procedure.

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Management of Ureteral Stones in Pediatric Patients

Abstract: Shockwave lithotripsy is a safe and efficient treatment modality for ureteral stones in pediatric patients. In expert hands, ureteroscopy can be successfully applied in case of SWL failure.

Cited by 22 publications

References 26 publications

Cystinuria in childhood and adolescence: recommendations for diagnosis, treatment, and follow-up

Cystinuria in childhood and adolescence: recommendations for diagnosis, treatment, and follow-up

Extracorporeal shock wave lithotripsy in the treatment of pediatric urolithiasis: a single institution experience

Outcomes of Shock Wave Lithotripsy and Ureteroscopy for Treatment of Pediatric Urolithiasis

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