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Pediatric urolithiasis: experience from a tertiary referral center
Abhishek1, Jatinder Kumar, Anil Mandhani
1Department of Urology and Renal transplantation, Sanjay Gandhi Postgraduate Institute of Medical Science, Raebreali Road, Lucknow 226014, U.P, India.
Insights
Pediatric urolithiasis management improved with endoscopy. Metabolic abnormalities are common in children with kidney stones and contribute to recurrence, highlighting the need for metabolic workup.
Area of Science:
- Pediatric Urology
- Nephrology
- Surgical Technology
Background:
- Pediatric urolithiasis presents significant morbidity, including kidney damage and potential renal failure.
- Effective management strategies are crucial for minimizing long-term complications in children.
Purpose of the Study:
- To review the management of pediatric urolithiasis at a tertiary referral center.
- To analyze factors influencing stone recurrence and treatment outcomes.
Main Methods:
- Retrospective review of medical records for children diagnosed with urolithiasis from August 2003 to October 2011.
- Management strategies were determined by stone burden and location.
- Data analyzed included patient demographics, clinical presentation, management interventions, metabolic workup, and recurrence rates.
Main Results:
- 325 children (378 stone sites) were included; mean age was 8 years (range 3-17), with a 3:1 male to female ratio.
- Abdominal pain was the most common symptom (79%); kidney stones were most frequent (57%).
- 24% of children experienced recurrence, more common with metabolic abnormalities or residual stone fragments.
Conclusions:
- Percutaneous endoscopy and ureteroscopy are safe and effective in children, with outcomes comparable to adults.
- Metabolic abnormalities are prevalent in pediatric urolithiasis patients and are a significant factor in stone recurrence.
Objective:
Pediatric urolithiasis can cause significant morbidity and damage to the kidney, or even renal failure. We review our experience of the management of urolithiasis in pediatric patients at a tertiary referral center.
Patients And Methods:
We reviewed medical records of all children with urolithiasis who were diagnosed and managed at our center from August 2003 to October 2011. Management was planned according to stone burden and location. We noted and statistically analysed data about age, sex, stone burden, clinical features, management, metabolic abnormalities and recurrence.
Results:
There were 325 children with 378 stone sites. Age range was 3-17 (mean 8) years. The male to female ratio was 3:1. Most common presentation was abdominal pain in 257 children (79%), and the most common stone site was kidney in 215 (57%). Twenty-four (7%) children (stone burden ≤3 mm) were managed conservatively, while the rest received some form of intervention. Metabolic workup could be done in 154 (47%) children. A metabolic abnormality was seen in 67 (43%) children, normocalcemic hypercalciuria being the most common. Recurrence of urolithiasis was seen in 78 (24%) children after a mean follow-up of 3.2 (1-6) years, and was more common in those who had a metabolic abnormality or in whom small residual fragments were left in situ.
Conclusions:
Availability of smaller instruments has led to safer use of percutaneous endoscopy and ureteroscopy in children, with results comparable to those in adults and an acceptable complication rate. The presence of a metabolic abnormality is quite common and is a cause of recurrence.
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