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Strategies for managing upper tract calculi in young children
V R Jayanthi1, P M Arnold, S A Koff
1Section of Urology, Columbus Children's Hospital, Ohio State University, USA.
Insights
Pediatric urolithiasis surgical management is effective in young children using minimally invasive techniques. Most children with upper tract calculi benefit from these approaches, with a high success rate and few complications.
Area of Science:
- Pediatric Urology
- Surgical Management
- Urolithiasis Treatment
Background:
- Pediatric urolithiasis is uncommon, with limited data on modern surgical techniques in young children.
- This study addresses the surgical management of upper tract calculi in prepubertal patients.
Purpose of the Study:
- To present a single-center experience with surgical management of upper tract calculi in prepubertal children.
- To evaluate the safety and efficacy of modern surgical procedures in this age group.
Main Methods:
- Retrospective review of 41 prepubertal patients (17 months to 14 years) undergoing surgical treatment for ureteral or renal calculi.
- Procedures included extracorporeal shock wave lithotripsy, ureteroscopy, percutaneous extraction, and open surgery.
- Patient data included presentation, comorbidities, treatment, outcomes, and complications.
Main Results:
- Extracorporeal shock wave lithotripsy was performed in 24 patients with a 67% stone-free rate.
- Ureteroscopic extraction was successful in 11 of 12 children (youngest 2.5 years) with no postoperative complications.
- Open surgery was required in 17% of cases, often for anatomical abnormalities or failed minimally invasive procedures.
- Metabolic abnormalities were detected in 80% of tested children.
Conclusions:
- Surgical management of pediatric upper urinary tract calculi is similar to adults.
- Minimally invasive techniques are safe and effective even in infants.
- Elective stenting is generally not required before lithotripsy.
- Open procedures remain necessary for a subset of cases.
- A high prevalence of metabolic abnormalities necessitates investigation.
Purpose:
Pediatric urolithiasis is relatively uncommon and there is little information on the application of modern surgical procedures in young children. We present a single center experience with the surgical management of upper tract calculi in this age group.
Materials And Methods:
We reviewed presentation, co-morbidity, treatment, outcome and complications in all prepubertal patients who required surgical treatment for ureteral or renal calculi during a 4-year period. The series consists of 24 girls and 17 boys 17 months to 14 years old (mean age 7.5 years). A total of 26 children were anatomically normal, and 4 had myelomeningocele, 4 had ureteropelvic junction obstruction (in a pelvic kidney in 1), 2 had cloacal anomalies, 2 had vesicoureteral reflux, and 1 each had nonrefluxing megaureter, orthotopic ureterocele and a functioning renal transplant.
Results:
Extracorporeal shock wave lithotripsy was performed in 24 patients. Stents or nephrostomy tubes were only used in the 4 patients who presented with pyonephrosis. Of the 41 cases 17 were rendered stone-free, 3 had a decreased stone burden and 4 were failures. Ureteroscopic extraction of distal ureteral calculi was successful in 11 of 12 children, of whom the youngest was 2.5 years old. No child had postoperative infection or evidence of ureteral obstruction. Stent placement facilitated stone passage or dissolution in 2 patients, a renal calculus was percutaneously extracted in 2 and 7 required open surgery, mostly for correcting simultaneous anatomical abnormalities or after minimally invasive surgery failed. Some metabolic abnormality was detected in 80% of the children tested.
Conclusions:
The surgical management of upper urinary tract calculi in young children parallels that in adults. Minimally invasive surgical methods may be safely used even in young infants. Most children do not need elective stenting before lithotripsy. Open procedures are still required in 17% of cases. The majority of children have definable metabolic abnormalities.