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[The lithiasis in the upper urinary tract in children: endourological treatment]
J Romero Otero1, A Gómez Fraile, J A Feltes Ochoa
1Sección de Urología Pediátrica, Hospital Universitario 12 de Octubre, Madrid. jromerootero@hotmail.com
Insights
Pediatric urolithiasis can be treated with endourological techniques. While ureteroscopy had a 57% success rate, percutaneous nephrolithotomy was highly effective for staghorn calculi, with all patients remaining asymptomatic post-treatment.
Area of Science:
- Urology
- Pediatric Surgery
- Endourology
Context:
- Pediatric urolithiasis is a growing concern, often presenting as upper urinary tract calcium oxalate stones.
- Clinical presentation and management strategies for pediatric urolithiasis increasingly mirror adult cases.
- Endourological approaches are becoming standard for treating pediatric urolithiasis.
Purpose:
- To present the technique and experience of endourological treatment for pediatric urolithiasis.
- To evaluate the efficacy and safety of percutaneous nephrolithotomy and ureteroscopy in children.
- To assess outcomes including stone-free rates, complications, and long-term renal function.
Summary:
- A retrospective study analyzed 7 pediatric patients (2.5-14 years) with upper urinary tract lithiasis treated endourologically.
- One case of staghorn calculus was managed with percutaneous nephrolithotomy (100% success, no complications).
- Six ureteroscopies were performed for ureteral stones, achieving a 57% success rate, with others requiring conversion to open surgery. All patients were asymptomatic post-treatment.
Impact:
- Endourological treatment for pediatric urolithiasis is feasible and requires individualized case management.
- Advancements in endourological materials and surgical experience are expanding the accessibility of these techniques for urologists.
- Successful endourological management leads to asymptomatic patients with normal renal function.
Introduction:
Urolithiasis in the pediatric age is a growing problem. In the developed world they are of calcium oxalate and in the upper urinary tract. It is very similar to the presentation of lithiasis in adults, so we have to make an effort to apply the experience in this age to the children. The shock wave lithotripsy is admitted as the first treatment for this pathology in the pediatric population already. The endourological approach must be use as a common approach in this group. We present our technique and experience.
Material And Methods:
A retrospective, descriptive study of the children diagnosed of lithiasis in the upper urinary tract that were treated by an endourological technique in our centre between January 1992 and January 2005. We gathered data on: 1.) Preoperative: age, sex, clinical manifestations, size (mm) and position of the lithiasis (we divided the upper urinary tract in: renal, proximal third, medial third and distal third) 2.) Operative variable: endourological technique: percutaneus neprolithotomy or ureteroscopy. Reconversion to open surgery. 3.) Postoperative variables: time since surgery, complications and the current state of the patient (ultrasonography and renal function).
Results:
Seven children, 4 boys and 2 girls with an age range of 2,5 to 14 years, underwent operation using an endourological technique. Lumboabdominal pain was the main clinical manifestation (4/7). The lithiasis size was 4-7mm, with the exception of a staghorn calculis. The calculis were: 5 ureteral proximal, 1 ureteral distal and one in the kidney (staghound stone). We performed one percutaneus neprolithotomy for the staghorn calculi. We removed completly the stone and had no complications. The 6 other procedures were ureteroscopies. In 3 of them we removed the calculi (4/7 success rate of 57%). The rest procedures we needed to transform in open surgery. With a following time of 1-13 years all of them are asymptomatic, and with ultrasonography and renal function in the normal limits. We did see no complications.
Conclusion:
The endourological treatment for urolithiasis in pediatric patients is possible but must be individualized in each case. With the development of new endourological material and more surgical experience this technique will be to the reach of the most of the urologists.
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