Minimally invasive treatment of urinary tract calculi in children
M Fraser1, A D Joyce, D F Thomas
1Pyrah Department of Urology, St. Joames's University Hospital, Leeds, UK.
Insights
Minimally invasive treatments for pediatric kidney stones are effective, with 88% of children becoming stone-free. These advanced techniques, including extracorporeal shock wave lithotripsy and percutaneous nephrolithotomy, offer a safe alternative to open surgery.
Area of Science:
- Pediatric Urology
- Nephrolithiasis Management
- Minimally Invasive Surgery
Background:
- Urinary tract calculi in children present unique management challenges.
- Historically, open stone surgery was the primary treatment modality.
- Developing minimally invasive techniques offers potential for improved outcomes.
Purpose of the Study:
- To evaluate a broad multimodality approach for treating pediatric urinary tract calculi.
- To report experience with extracorporeal shock wave lithotripsy (ESWL), ureteroscopy/laser lithotripsy, lithoclast, and percutaneous nephrolithotomy (PCNL) in children.
- To assess the safety and efficacy of these minimally invasive procedures in a pediatric cohort.
Main Methods:
- Retrospective review of 43 children treated between 1990 and 1997.
- Utilized a range of minimally invasive modalities, singly or in combination.
- Included extracorporeal shock wave lithotripsy (ESWL), ureteroscopy/laser lithotripsy, lithoclast, and percutaneous nephrolithotomy (PCNL).
Main Results:
- 88% (38 of 43) of children were rendered stone-free.
- Complications requiring intervention occurred in 7% (2 of 43) of patients.
- Three children required subsequent open surgery after unsuccessful minimally invasive treatment.
Conclusions:
- Minimally invasive procedures, including ureteroscopy and PCNL, are safe and effective for pediatric urinary tract calculi.
- Selective application of these techniques can replace open surgery.
- Advancements in pediatric-specific instruments will further reduce the role of open surgery.
Objective:
To report experience of a broad multimodality approach to the treatment of calculi in children using extracorporeal shock wave lithotripsy (ESWL), ureteroscopy/laser lithotripsy, lithoclast and percutaneous nephrolithotomy (PCNL).
Patients And Methods:
The treatment and outcome were reviewed in 43 children managed by a range of minimally invasive modalities, either singly or in combination, between 1990 and 1997. These patients represent a selected group deemed suitable for minimally invasive management during a period of developing experience with these techniques. Of this cohort, six children had previously undergone open stone surgery and contributory metabolic abnormalities were identified in seven. ESWL was the sole treatment modality in 24 children (56%). In five children (12%) ureteroscopy/laser lithotripsy was combined with ESWL, eight (18%) underwent ureteroscopy/laser lithotripsy alone, whilst three with bladder stones were treated with the lithoclast. Combined therapy including PCNL was required in three patients.
Results:
Of the 43 children treated, 38 (88%) were rendered stone-free. Metabolic disorders accounted for three of the five cases of residual calculi. Complications requiring intervention occurred in two children (7%) and three subsequently underwent open pyelolithotomy or ureterolithotomy after unsuccessful minimally invasive treatment.
Conclusions:
Used selectively, the range of minimally invasive procedures available for adults, including ureteroscopy and PCNL, can be safely and effectively extended to the treatment of urinary tract calculi in children. The role of open surgery will diminish further with the availability of specialized instruments for paediatric PCNL.
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