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Published on: June 21, 2024
[Urolithiasis in childhood]
1Urologische Klinik Sindelfingen, Klinikum Sindelfingen-Böblingen, Lehrkrankenhaus der Universität Tübingen, Arthur-Gruber-Straße 70, 71065 Sindelfingen, Deutschland. t.knoll@klinikverbund-suedwest.de
Insights
Pediatric urinary stone disease, though rare, often indicates underlying metabolic issues. Prompt stone analysis and metabolic evaluation are crucial for managing recurrent stones and preserving kidney function in children.
Area of Science:
- Pediatric Nephrology
- Urology
- Metabolic Disorders
Context:
- Urinary stone disease affects 1-2% of children.
- Often linked to metabolic abnormalities, leading to recurrence.
- First stone event necessitates thorough evaluation.
Purpose:
- Outline objectives for pediatric stone management.
- Emphasize complete stone clearance and recurrence prevention.
- Highlight the importance of metabolic evaluation and correction.
Summary:
- Stone analysis and metabolic workup are mandatory after the first pediatric stone.
- Management goals include stone clearance, recurrence prevention, and renal function preservation.
- Minimally invasive procedures like ESWL, PCNL, and ureterorenoscopy are primary treatment options.
- Open/laparoscopic surgery is reserved for complex anatomical cases.
Impact:
- Facilitates optimal stone management strategies in pediatric patients.
- Aims to prevent long-term renal damage and recurrent stone formation.
- Guides clinical practice towards comprehensive care for children with urinary stones.
Abstract:
Urinary stone disease is relatively rare in children with an overall incidence of 1-2 %; however, it is often associated with metabolic abnormalities that may lead to recurrent stone formation. Stone analysis and subsequent metabolic evaluation is therefore mandatory for this high-risk group after the first stone event. The objectives of stone management in children should be complete stone clearance, prevention of stone recurrence, preservation of renal function, control of urinary tract infections, correction of anatomical abnormalities and correction of the underlying metabolic disorders. The full range of minimally invasive procedures is available if active stone removal is necessary. The majority of stones in children can be managed either with extracorporeal shock wave lithotripsy which has a higher efficacy in children than in adults, percutaneous nephrolithotomy, ureterorenoscopy or a combination of these modalities while open or laparoscopic surgery is limited to well-selected cases with underlying anatomical abnormalities.
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