The evolution of the endourologic management of pediatric stone disease

Smaldone, Marc C.; Gayed, Bishoy A.; Ost, Michael C.

doi:10.4103/0970-1591.56177

Cited by 11 publications

(7 citation statements)

References 53 publications

(84 reference statements)

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“…15–19 These characteristics also made SWL a good treatment option for children with stones that were difficult to pass, particularly compared to percutaneous nephrolithotomy or open ureterolithotomy, the primary treatment alternatives to SWL for much of the 1980s. 10,20,21 Indeed, even today SWL forms the cornerstone of pediatric endourological management in guidelines issued by the American Urological Association and the European Association of Urology. 8 …”

Section: Discussionmentioning

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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Section: Discussionmentioning

confidence: 99%

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

et al. 2016

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“…Open surgery was the primary treatment of choice, till the advent of SWL in the 1980's that paved the way for the revolution in pediatric stone management. [ 3 7 ] This is currently the procedure of choice in treating most upper urinary tract calculi in children <1.5 cm,[ 8 ] open surgery being confined only to complex stones. [ 9 ] However, the stone-free rates of SWL are low, with only 37–52% of children stone-free at discharge according to a large-scale study.…”

Section: Discussionmentioning

confidence: 99%

“…[ 11 ] According to world literature, PCNL is generally used for the treatment of large stone burdens >1.5 cm in children, with efficacy and complication rates similar to the adult population. [ 7 8 ] In fact, PCNL has now replaced open surgery as the treatment of choice for large stone burdens in children of all ages. [ 3 ] However, the dangers of using large instruments in smaller kidneys leading to hemorrhage and lower tolerance of blood loss, extensive parenchymal damage, and the associated effects on renal function have been a deterrent to its widespread usage.…”

Section: Discussionmentioning

confidence: 99%

Mini percutaneous nephrolithotomy for renal calculi in paediatric patients: A review of twenty cases

Dsouza

Paul

2016

Urol Ann

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Objective:The objective was to report our initial experience of mini percutaneous nephrolithotomy (mPCNL) performed on patients in the pediatric age group (<18 years) using a miniature nephroscope (12F).Subjects and Methods:A total of 20 children underwent mPCNL for renal stone extraction in the Department of Urology, Yenepoya Medical College, Mangalore, India, from February 2013 to January 2014. The patients were evaluated on the basis of parameters viz. age at the time of surgery, size and number of stones, duration of surgery, stone clearance, and postoperative complications.Results:A total of 20 mPCNLs were performed on children, with age ranging from 8 to 16 years. Three children had three stones each, six children had two stones each, eight children had one stone each, and three had multiple. The median stone burden was 1.36 cm. The procedure was via single puncture in 15 cases, and two punctures in five cases. Punctures were upper calyceal in seven cases, lower calyceal in seven cases, and combined upper and lower calyceal in six cases. The calculi were accessed by a 12F mini nephroscope, laser lithotripsy was used in 12 cases and pneumatic lithotripsy used for the rest. Total clearance was achieved in 18 out of 20 cases (90%). Postoperative complications developed in one child, in the form of sepsis.Conclusion:Our initial experience concludes that mPCNL is a safe and efficacious tool for the management of renal calculi in the pediatric population.

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“…The remaining ones need conservative treatment or surgical treatment. The choice of the most appropriate method of treatment depends on many factors, i.e., the location, size and stone composition, the age of the patient, anatomical conditions, grade of urinary reflux disorder, recurrent urinary tract infections [13].…”

Section: Treatmentmentioning

confidence: 99%

Urolithiasis in Children – A Health Problem of Civilization

Jurkiewicz

Samotyjek

2017

hpc

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Authors' contribution Wkład autorów: A. Study design/planning zaplanowanie badań B. Data collection/entry zebranie danych C. Data analysis/statistics dane-analiza i statystyki D. Data interpretation interpretacja danych E. Preparation of manuscript przygotowanie artykułu F. Literature analysis/search wyszukiwanie i analiza literatury G. Funds collection zebranie funduszy Summary In the past 25 years, the incidence of urolithiasis in the paediatric population increased twofold. The reasons for the increased morbidity are not completely clear, but it is believed that many different factors impact this situation including bad eating habits, salty diets, inadequate fluid intake, obesity, hypertension, environmental pollution or uncontrolled multivitamin intake. At the same time, improving diagnostics quality and its availability contributed to an increase in the detection of urolithiasis. The paediatric population is subject to high risk of disease recurrence; therefore, it is essential to choose a method of treatment that provides a stone removal in a minimally invasive but effective way. Over 80% of bladder stones are evacuated spontaneously and do not require surgical intervention. The remaining ones need conservative or surgical treatment. A choice of the most appropriate method depends on many factors. The procedures of surgical treatment of urolithiasis in children include ESWL, URSL, RIRS, PCNL and pyelolithotomy using a laparoscopic or open technique. Urolithiasis in children is a severe interdisciplinary problem because of its more common prevalence. Its formation requires a thorough recognition, proper treatment by a nephrologist and the use of efficient, effective and minimally invasive surgical procedure.

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The evolution of the endourologic management of pediatric stone disease

Cited by 11 publications

References 53 publications

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

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

Mini percutaneous nephrolithotomy for renal calculi in paediatric patients: A review of twenty cases

Urolithiasis in Children – A Health Problem of Civilization

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