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Treatment of pediatric renal stones in a Western country: a changing pattern
Annamaria Salerno1, Simona Gerocarni Nappo, Ennio Matarazzo
1Division of Pediatric Urology, Department Nephrology and Urology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
Insights
Minimally invasive pediatric kidney stone treatments like PCNL and RIRS have increased, while ESWL has decreased. Open surgery is now rarely needed for kidney stones in children.
Area of Science:
- Pediatric Urology
- Endourology
- Nephrolithiasis Management
Background:
- Miniaturization of endoscopic instruments has enabled minimally invasive procedures for pediatric kidney stones.
- This report details the evolution of kidney stone management in a European tertiary care center over a decade.
Purpose of the Study:
- To analyze the changes in kidney stone treatment patterns in children.
- To compare therapeutic options and outcomes between two distinct time periods.
Main Methods:
- Retrospective review of 333 pediatric patients treated for kidney stones from 2002-2011.
- Comparison of two groups: 2002-2006 (Group A) and 2007-2011 (Group B).
- Therapeutic options included Extracorporeal Shock Waves Lithotripsy (ESWL), Retrograde Intrarenal Surgery (RIRS), Percutaneous Lithotripsy (PCNL), and open surgery. Outcomes assessed were primary treatment, stone-free rate, and retreatment. Statistical analysis used the chi-square test (p <0.05).
Main Results:
- Extracorporeal Shock Waves Lithotripsy (ESWL) use decreased by 34% in Group B compared to Group A.
- Retrograde Intrarenal Surgery (RIRS) and Percutaneous Lithotripsy (PCNL) use increased by 17% and 16% respectively in Group B.
- Open surgery was not required for primary lithiasis cases without congenital malformations.
Conclusions:
- Percutaneous Lithotripsy (PCNL) and Retrograde Intrarenal Surgery (RIRS) have significantly altered pediatric renal stone treatment.
- A notable increase in endourologic minimally invasive procedures for pediatric kidney stones was observed.
- Open surgery is now an infrequent option for pediatric kidney stone management.
Background:
Over the last 10years the miniaturization of endoscopic instruments made minimally invasive procedures for kidney stones feasible even in children. The evolution in management of kidney stones in a tertiary care center in Europe is reported.
Methods:
Patients treated in our hospital for kidney stones from 2002 to 2011 were reviewed and group A (2002 to 2006) was compared with group B (2007 to 2011). The therapeutic options offered were Extracorporeal Shock Waves Lithotripsy (ESWL), Retrograde Intrarenal Surgery (RIRS), Percutaneous Lithotripsy (PCNL) and open surgery. Outcome measures were: first treatment chosen, stone free rate after a single procedure, and retreatment. Results were compared by chi-square test, with p <0.05 considered statistically significant.
Results:
333 patients, mean age 9.7years, were treated, 161 in group A and 172 in group B. ESWL was the first option in both groups, but decreased by 34% in group B vs A. In contrast, RIRS and PCNL increased by 17% and 16%, respectively, in group B vs group A. Open surgery was never required in primary lithiasis cases without associated malformations.
Conclusion:
The advent of PCNL and RIRS has significantly changed the pattern of renal stone treatment in the pediatric age group. A progressive increase of endourologic minimally invasive procedures was recorded. Open surgery should be a very rare option.
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