The evolution of the endourologic management of pediatric stone disease

Area of Science:

• Pediatric Urology
• Endourology
• Nephrolithiasis Management

Background:

• Shock wave lithotripsy (SWL) has been the standard for pediatric upper tract calculi <1.5 cm since the 1980s.
• Advances in instrumentation and surgical techniques have led to increased use of ureteroscopy (URS) and percutaneous nephrolithotomy (PCNL) in children.
• PCNL has largely replaced open surgery for large pediatric stones (>2 cm), with outcomes comparable to adults.

Purpose of the Study:

• To provide a comprehensive review of endourologic stone management in children.
• To evaluate indications, techniques, complications, and efficacy of SWL, URS, and PCNL.
• To highlight the need for randomized controlled trials comparing treatment modalities.

Main Methods:

• Literature review of endourologic stone management in pediatric patients.
• Analysis of data from retrospective reviews and single-institution series.
• Evaluation of efficacy, stone-free rates, and complication profiles.

Main Results:

• URS and PCNL show comparable stone-free and complication rates to SWL in some studies.
• Concerns persist regarding potential renal development and urinary tract damage with URS and PCNL in pediatric populations.
• SWL remains a primary choice for smaller pediatric stones, while PCNL is preferred for larger stone burdens.

Conclusions:

• Endourologic techniques like URS and PCNL are increasingly utilized in pediatric stone management.
• Further research, particularly randomized controlled trials, is essential to establish optimal primary treatment modalities for pediatric upper tract stones.
• Long-term outcomes and safety of URS and PCNL in children require continued investigation.