Related Experiment Videos
Pediatric stone disease: an evolving experience
Kevan Sternberg1, Saul P Greenfield, Pierre Williot
1Department of Pediatric Urology, Women and Children's Hospital of Buffalo and Department of Urology, State University of New York at Buffalo School of Medicine, Buffalo, New York 14222, USA.
Insights
Pediatric kidney stones are often calcium-based and occur without metabolic issues. Most patients pass stones or are treated successfully with extracorporeal shock wave lithotripsy.
Area of Science:
- Urology
- Pediatric Nephrology
Background:
- Pediatric stone disease management has evolved with early diagnosis and technological advancements.
- Understanding trends in pediatric urolithiasis is crucial for effective treatment.
Purpose of the Study:
- To review a 12-year experience with pediatric stone disease.
- To analyze the presentation, management, and outcomes of pediatric urolithiasis.
Main Methods:
- Retrospective review of 123 pediatric patients (8 months to 25 years) with 158 stones (1991-2003).
- Evaluation included 24-hour urine collection (41%) and serum chemistry (54%).
- Analysis of stone presentation, symptoms, underlying conditions, and treatment modalities.
Main Results:
- Calcium-based stones (88%) were most common, often without metabolic abnormalities.
- Loin pain (76%) and history of urinary tract infections (11%) were frequent presentations.
- 46% passed stones spontaneously; extracorporeal shock wave lithotripsy (ESWL) was successful in 71% of treated patients.
Conclusions:
- Pediatric kidney stones are predominantly calcium-based and frequently occur without identifiable metabolic disturbances.
- While many stones pass spontaneously, ESWL is highly effective for those requiring intervention.
- Congenital abnormalities and neurogenic bladder were uncommon, suggesting improved early diagnosis and management.
Purpose:
The presentation and management of pediatric stone disease have changed due to early identification and treatment of congenital urological conditions, as well as technological advances. Therefore, we reviewed our 12-year experience.
Materials And Methods:
A total of 123 patients with 158 stones presented from 1991 to 2003. The 46 boys and 77 girls were 8 months to 25 years old, including 5 boys (4%) younger than 3 years, 46 (37%) 4 to 12 years old and 72 (59%) older than 13 years. A 24-hour urine collection was done in 50 patients (41%) and serum chemistry studies were performed in 66 (54%).
Results:
The seasons of presentation were fall in 41% of cases, summer in 24%, spring in 22% and winter in 13%. Of the patients 94 (76%) had loin pain, 10 (8%) had urinary tract infections, 13 (11%) had a history urinary tract infection, 18 (15%) had gross hematuria, 14 (11%) had structural urological abnormalities and 7 (6%) had neurogenic bladder. Metabolic abnormalities were uncommon and included hypercalciuria in 12%, hyperoxaluria in 2% and cystinuria in 2%. A total of 57 patients (46%) passed the stones and 34 (28%) underwent extracorporeal shock wave lithotripsy, of whom 24 (71%) became stone-free. Ureteroscopy was performed in 10 patients (8%) 6 to 19 years old, percutaneous nephrostolithotomy was done in 4 (3%) and 4 (3%) underwent open surgery. Stone analysis showed calcium based in 88% of the cases, struvite in 7% and cystine in 5%.
Conclusions:
The majority of patients had no congenital abnormalities. Early diagnosis of urological abnormalities and urinary infection, and appropriate management of neurogenic bladder may have reduced the incidence in those groups. Most stones are calcium based but occur in the absence of metabolic disturbances. More patients presented in the fall, perhaps reflecting the increased concentration of urine in the summer. Half of the patients passed the stones and shock wave lithotripsy was curative in most others. Ureteroscopy, percutaneous nephrostolithotomy and open surgery were rarely required.
Related Concept Videos
01:27Urinary Tract Calculi IV: Nutrition Therapy and Prevention
01:30Urinary Tract Calculi III: Medical Management
01:28Urinary Tract Calculi V: Nursing Management
01:25Urinary Tract Calculi VI: Surgical Management
01:26Pharmacokinetics in Pediatric Patients: Drug Excretion
01:26Urinary Tract Calculi II: Pathophysiology and Clinical Manifestations