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Management of calculus anuria in children: experience of 54 cases
Mohammed A Elgammal1, Mohammed S Abdel-Kader, Adel Kurkar
1Department of Urology, Section Pediatric Urology, Assiut University Hospital, Assiut 71526, Egypt. mo_elgammal@yahoo.com
Insights
Peritoneal dialysis is effective for critically ill children with calculus anuria. Formal surgery offers a low complication rate and good outcomes for stable children requiring urinary diversion.
Area of Science:
- Pediatric Nephrology
- Urology
- Critical Care Medicine
Background:
- Calculus anuria in children presents significant management challenges.
- Treatment strategies vary based on patient condition and stone localization.
Purpose of the Study:
- To compare the outcomes of different treatment modalities for calculus anuria in pediatric patients.
- To evaluate the efficacy and complication rates of various interventions.
Main Methods:
- Patients were stratified into three groups based on illness severity and biochemical parameters.
- Group A (critically ill) received peritoneal dialysis.
- Groups B and C (stable) underwent urinary diversion via percutaneous nephrostomy, JJ stent, or open surgery depending on stone localization.
Main Results:
- All 54 patients achieved normal renal function within 72-120 hours.
- Peritoneal dialysis showed high effectiveness in critically ill children.
- Complication rates varied: Group A (26%), Group C (13%), Group B (percutaneous nephrostomy 66%, JJ stent 50%).
Conclusions:
- Peritoneal dialysis is a highly effective treatment for calculus anuria in critically ill children.
- Urinary diversion procedures in children are associated with considerable complication rates.
- Formal surgery in stable pediatric patients with localized stones yields favorable outcomes and rapid recovery.
Objective:
To evaluate the outcome of different treatment plans for calculus anuria in children.
Patients And Methods:
Patients were subdivided into three groups, A, B and C. Group A included patients who were critically ill, had serum creatinine> or =3.5mg/dl, blood urea> or =100mg/dl, serum potassium> or =7meq/l and/or blood pH< or =7.1; and they were treated initially by peritoneal dialysis. Patients in groups B and C were stable with serum creatinine<3.5mg/dl, blood urea<100mg/dl, serum potassium level<7meq/l and blood pH>7.1. In group B, the obstructing stone could not be localized, and they were treated either by percutaneous nephrostomy or JJ stent. In group C, stone level was confidently determined and patients were treated by open surgery.
Results:
Fifty-four patients were included. All patients regained normal serum creatinine levels within 72-120h. Overall complication rate in groups A and C was 26% and 13%, respectively. In group B, overall complication rate was 66% for percutaneous nephrostomy and 50% for internal stent.
Conclusions:
Urinary diversion in children is associated with a high complication rate while dialysis is highly effective in children. Formal surgery in compensated children is associated with a low complication rate with good outcome and early recovery.
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