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Management of pediatric urolithiasis in Pakistan: experience with 1,440 children
S A Rizvi1, S A Naqvi, Z Hussain
1Sindh Institute of Urology and Transplantation, Dow Medical College, Karachi, Pakistan.
Insights
Minimally invasive surgery significantly improved pediatric urolithiasis treatment outcomes. Extracorporeal shock wave lithotripsy and ureterorenoscopy offer effective alternatives to open surgery for pediatric kidney stones.
Area of Science:
- Pediatric Urology
- Surgical Innovation
- Medical Technology
Background:
- Pediatric urolithiasis presents unique challenges in developing countries.
- Treatment modalities have evolved significantly over two distinct eras.
- Assessing the impact of minimally invasive surgery is crucial for improving care.
Purpose of the Study:
- To evaluate the efficacy and safety of various pediatric urolithiasis treatments.
- To compare outcomes before and after the introduction of minimally invasive surgical techniques.
- To analyze treatment trends in a developing country context.
Main Methods:
- Retrospective review of 1,440 pediatric patients (<14 years) over 14 years.
- Analysis of treatment modalities including open surgery, extracorporeal shock wave lithotripsy (ESWL), and minimally invasive methods.
- Comparison of data from 1987-1995 (pre-minimally invasive era) and 1996-2000 (post-minimally invasive era).
Main Results:
- Minimally invasive techniques (ESWL, percutaneous nephrolithotomy, ureterorenoscopy) showed high stone clearance rates for renal, ureteral, and bladder calculi.
- ESWL achieved 84% clearance for renal stones, ureterorenoscopy 86.9% for ureteral stones, and transurethral pneumatic cystolithotripsy 93% for bladder stones.
- Open surgery demonstrated high efficacy (98% for renal stones) but is now reserved for complex cases.
Conclusions:
- The adoption of extracorporeal shock wave lithotripsy, percutaneous nephrolithotomy, and ureterorenoscopy has enhanced pediatric urolithiasis management.
- These minimally invasive approaches lead to shorter hospital stays and quicker return to daily activities for children.
- Open surgery remains essential for complex stone burdens, while less invasive methods are preferred for routine cases.
Purpose:
We evaluated the efficacy and safety of different modalities for pediatric urolithiasis in a developing country in 2 eras, namely before and after the advent of minimally invasive surgery.
Materials And Methods:
We retrospectively reviewed the records of 1,440 children younger than 14 years treated with various modalities during a 14-year period. From 1987 to 1995, 486 and 50 patients were treated with open surgery, and extracorporeal shock wave lithotripsy (ESWL, Dornier Medical Systems, Inc., Marietta, Georgia) and minimally invasive methods, respectively. Between 1996 and 2000, 518 and 386 children were treated with surgery and minimally invasive methods, respectively.
Results:
Of the 1,440 children 795 (55.2%) had renal, 198 (13.8%) had ureteral and 447 (31%) had bladder calculi. Of the renal stones 556 (70%), 177 (22%) and 62 (7.8%) were treated with open surgery, ESWL and percutaneous nephrolithotomy, respectively. Of the ureteral calculi 85 (43%), 37 (18.6%) and 76 (38%) were managed by ESWL, ureterorenoscopy and open surgery, respectively. Of the bladder calculi 307 (68%), 77 (17.2%) and 63 (14%) were treated with open vesicolithotomy, transurethral pneumatic cystolithotripsy and ESWL, respectively. The renal stone clearance rate was 98% after open surgery, 84% after ESWL and 68% after percutaneous nephrolithotomy monotherapy at 3 months of followup. Similarly the ureteral stone-free rate was 54% after ESWL and 86.9% after ureterorenoscopy. Of the patients with bladder calculi 48% and 93% become stone-free after ESWL and transurethral pneumatic cystolithotripsy, respectively.
Conclusions:
The use of ESWL, percutaneous nephrolithotomy and ureterorenoscopy has resulted in treating a large number of children with a short hospital stay and early return to school. Open surgery is reserved only for complex stones.