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Endoscopic management of pediatric urolithiasis in a developing country
Endre Holman1, A Munim Khan, Tibor Flasko
1Department of Urology, Semmelweis Hospital, Kiskunhalas, Hungary.
Insights
Endoscopic management of pediatric urolithiasis is safe and effective, with a 98.9% success rate and minimal complications. This study presents the largest series of endoscopic stone removal in children, highlighting ammonium urate as a common stone component.
Area of Science:
- Pediatric Urology
- Endourology
- Nephrolithiasis Management
Background:
- Pediatric urolithiasis presents unique challenges in diagnosis and management.
- Endoscopic techniques offer minimally invasive options for stone removal in children.
Purpose of the Study:
- To evaluate the safety and efficacy of endoscopic management for pediatric urolithiasis.
- To report the largest series of endoscopic stone removal in pediatric patients in Yemen.
Main Methods:
- A retrospective review of 290 endoscopic procedures on 265 pediatric patients (up to 14 years) from 1993-1998.
- Procedures included percutaneous nephrolithotomy, ureteral lithotripsy, and percutaneous cystolithotomy.
- Utilized adult nephroscopes and semirigid ureteroscopes.
Main Results:
- Overall success rate of 98.9% with no severe complications.
- Minor complications occurred in 10.7% of patients.
- Ammonium urate was the primary stone component in 73.5% of cases, particularly in younger children and lower urinary tract stones.
Conclusions:
- Endoscopic management of pediatric urolithiasis is a safe and effective treatment modality.
- This study represents a significant contribution to the literature on pediatric endourology.
- Understanding stone composition, like ammonium urate, may inform future treatment strategies.
Objectives:
To evaluate our experience with the endoscopic management of lower and upper urinary tract stones in pediatric patients in the Republic of Yemen.
Methods:
From January 1, 1993 to December 31, 1998, 290 endoscopic operations were performed on 265 pediatric patients up to 14 years of age, 173 on the upper and 117 on the lower urinary tract. Of these procedures, 138 were percutaneous nephrolithotomy, 5 were endopyelotomy combined with percutaneous nephrolithotomy, 30 were ureteral lithotripsy, and 117 were percutaneous cystolithotomy. Of the 265 patients, 244 were boys and 21 girls (male/female ratio 11.6:1, upper tract 7.4:1, lower tract 116:1) aged 8 months to 14 years (mean age 7.1 years). The 26F adult nephroscope and 9.5F semirigid ureteroscope were used.
Results:
The overall success rate was 98.9%. Minor complications were observed in 29 patients (10.7%); severe complication did not occur. The nucleus and/or the main component of the stones was ammonium urate in 73.5% of the cases (upper tract 54%, but for those younger than 5 years, it was 75%; lower tract 93%).
Conclusions:
The endoscopic management of pediatric urolithiasis is a safe and effective method. To our knowledge, this is the largest reported series on the endoscopic management of pediatric urolithiasis.