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Published on: September 13, 2022
[Management of pediatric urolithiasis in our center]
C Montalvo Avalos1, A Gómez Farpón2, N Vega Mata2
1Servicio de Cirugía Pediátrica, Hospital Universitario Central de Asturias, Oviedo. cristinamontalvo_avalos@hotmail.com
Insights
Pediatric urolithiasis is uncommon but linked to metabolic and urologic issues. Minimally invasive treatments like ureteroscopy show promise for effective and safe management of pediatric kidney stones.
Area of Science:
- Pediatric Nephrology
- Urology
- Pediatric Surgery
Context:
- Pediatric urolithiasis (kidney stones in children) is a rare condition.
- A significant percentage of cases are associated with underlying metabolic or nephro-urological malformations.
- The study reviews cases from 1998-2010, providing a historical perspective.
Purpose:
- To characterize the clinical, epidemiological, and therapeutic aspects of pediatric urolithiasis.
- To evaluate the effectiveness of different surgical interventions for pediatric kidney stones.
- To identify common presentations, locations, and complications of pediatric urolithiasis.
Summary:
- A retrospective review of 32 pediatric patients (mean age 4.5 years) with urolithiasis was conducted.
- Urinary tract infections and abdominal pain were the most frequent symptoms.
- Minimally invasive procedures (ureteroscopy, extracorporeal lithotripsy, percutaneous nephrolithotomy) were employed with varying success rates.
Impact:
- Highlights the association between pediatric urolithiasis and underlying pathologies, emphasizing the need for further investigation.
- Demonstrates the efficacy and safety of minimally invasive surgical techniques in managing pediatric kidney stones.
- Provides insights into treatment outcomes and complication rates, including recurrence, in pediatric urolithiasis.
Objectives:
To determine clinical, epidemiological and therapeutic characteristics of pediatric urolithiasis in our institution.
Material And Methods:
We reviewed retrospectively patients diagnosed with urolithiasis between 1998 and 2010 in our hospital.
Results:
A total of 32 patients (19 males and 13 females) with a mean age of 4.5 years (SD 1.9) were studied. 72% had a history of metabolic or nephro-urological malformations. The most common presentation was urinary tract infection (53%) and abdominal pain (21%). The diagnosis was made by ultrasound, with compatible X-ray in 18 cases. The most common location was pyelocalyceal level, affecting the left kidney mostly. A 38% had multiple stones with a size of 11 mm medium (3-30 mm). Ureteroscopy was used 16 times for stones in the bladder and distal ureter, with an effectiveness of 75%, and 2 patients required laparoscopic trocar cystotomy for removal. 8 extracorporeal lithotripsy procedures were performed (25% success) and 8 percutaneous nephrolithotomy procedures (37.5% success). In 3 patients we decided to perform a lumbotomy due to the size of the calculi, and, in 1 patient nephrectomy was necessary due to malfunction. The most common complication was lithiasis recurrence in 10 patients, most with multiple stones or metabolic alterations, and favourable outcome for the rest.
Conclusions:
Pediatric urolithiasis is uncommon, showing an increased incidence in patients with a history of metabolic and urologic pathology; it is important to do additional studies. In the last few years, it has been demonstrated that surgical treatment using minimally invasive procedures is effective and safe.
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