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Childhood urolithiasis: experiences and advances
J P Gearhart1, G Z Herzberg, R D Jeffs
1Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins Hospital and Children's Center, Baltimore, Maryland 21205.
Insights
Pediatric urolithiasis (kidney stones) often stems from underlying conditions, presenting with pain and hematuria. Management varies, with many requiring intervention, and recurrence is notable in children.
Area of Science:
- Pediatric Nephrology
- Urology
- Pediatric Surgery
Background:
- Urolithiasis in children is a significant clinical challenge.
- Identifying underlying causes is crucial for effective management.
- Common symptoms include flank/abdominal pain and gross hematuria.
Purpose of the Study:
- To analyze the clinical characteristics, causes, and outcomes of pediatric urolithiasis.
- To evaluate treatment modalities and recurrence rates in children with kidney stones.
- To discuss recent advances in urolithiasis management for pediatric patients.
Main Methods:
- Retrospective analysis of 54 pediatric patients with urolithiasis.
- Evaluation of symptoms, stone etiology, stone composition, and treatment outcomes.
- Follow-up assessment for stone recurrence over a 10-year period.
Main Results:
- Most stones (86%) were secondary to pre-existing conditions.
- Common symptoms were flank/abdominal pain (58%) and gross hematuria (28%).
- Urinary tract infections (UTIs) were present in 47% of patients; calcium oxalate and struvite stones were frequent in this group.
- 39% passed stones spontaneously, while 43% required intervention (surgery or ESWL).
- Recurrence was observed in 20% of patients.
Conclusions:
- Pediatric urolithiasis is frequently associated with underlying conditions and UTIs.
- A significant proportion of children require medical or surgical intervention for stone removal.
- Recurrence highlights the need for long-term monitoring and management strategies.
Abstract:
Between June 1979 and June 1989, 54 children with urolithiasis were evaluated and treated at the Johns Hopkins Children's Center. The most common symptoms were flank or abdominal pain (58%) and gross hematuria (28%). In 46 children (86%), stones were secondary to a preexisting condition and in only 8 (14%) no apparent cause of stone formation could be found. Thirty-six patients (66%) had a solitary stone, most commonly found in the kidney. Urinary tract infections were present in 25 (47%) of the patients who had stones. Stones composed either of calcium oxalate or struvite were the most frequently recovered in these patients with infections. Twenty-one patients (39%) spontaneously passed their stones whereas 23 (43%) required either surgery or extracorporeal shock-wave lithotripsy to resolve stones. Ten (20%) showed recurrence of their urolithiasis, with follow-up examination periods ranging from 1 month to 10 years. Recent advances in the management of urolithiasis and their applicability to the pediatric population are discussed.