Paediatric urolithiasis in emerging economies

Abstract

Paediatric urolithiasis remains a devastating health problem in low resource settings. MIS offers relief to majority of patients with excellent stone free rates and short hospital stay. Preventable strategies have to be put in place by improving nutrition and eliminating risk factors by diet and medical intervention.

Update on Surgical Management of Pediatric Urolithiasis

“…The outcome in terms of stone clearance and complication rates is excellent and comparable. Although PL has the advantage of being significantly cheaper as compared to LL, PL can only be used through 6/7.5FG ‘scopes and above, while LL can be used with the small ‘scopes (4.5/6FG), which is an advantage for infants and small children (2, 5, 79, 82, 83).…”

“…Urolithiasis presents in all age groups including children from the neonatal period onward and may even be picked up on prenatal ultrasound (1). Apart from a high prevalence of pediatric urolithiasis in endemic areas (2, 3), there is an increasing incidence all over the world (4). Within the pediatric age group, clinical presentations are varied, and evaluation, including imaging, and management have to be modified depending on whether they are infants, preschool children, or pre- or post-pubertal teenagers (2, 5–7).…”

“…Historically, all stones are treated by open surgery (15–17). Currently, with the advent of MIS, the majority of the stones are managed by MIS utilizing extracorporeal shockwave lithotripsy (ESWL), percutaneous nephrolithotomy (PCNL), and ureteroscopy/retrograde intrarenal surgery (URS/RIRS) (2, 18, 19). Undertaking MIS in small children is challenging (20), which to a certain extent has been overcome by improvement in technology by the development of miniaturized instruments, which are referred to appropriately as Miniperc or Microperc (21–28).…”

Trends of intervention for paediatric stone disease over the last two decades (2000–2015): A systematic review of literature

“…Publication trends reflect changes in clinical practice and new surgical innovations. Over the last two decades, there has been a gradual rise in kidney stone disease (KSD) and related interventions in paediatric patients [1] , [2] , [3] . In certain parts of Europe, the Middle East and Asia, the incidence is quoted to be as high as 15% and can account for up to 4–8% of end-stage renal disease [4] , [5] .…”

“…The incidence and characteristics of stones show a wide geographical variation in children [3] , [4] . With a high risk of recurrence, safe and effective treatment is paramount.…”