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Management of stone disease in infants
Mujdem Nur Azili1, Fatma Ozturk2, Mihriban Inozu3
1Department of Pediatric Surgery, Ankara Child Diseases Hematology and Oncology Education and Research Hospital, No:10 Diskapi, 06110, Ankara, Turkey. drmujdemazili@yahoo.com.
Insights
Retrograde intrarenal surgery (RIRS) is an effective and safe treatment for infant renal stones. This approach is recommended as a first-line therapy, especially for complex cases like cystinuria.
Area of Science:
- Pediatric Urology
- Nephrology
- Surgical Innovation
Background:
- Infant renal stone disease presents unique diagnostic and therapeutic challenges.
- Surgical interventions for pediatric urolithiasis require careful consideration of patient age and stone characteristics.
Purpose of the Study:
- To evaluate the efficacy and safety of surgical treatments for renal stones in infants under one year of age.
- To compare different surgical modalities including ESWL, endourological, and open procedures.
Main Methods:
- Retrospective review of 121 infants treated for renal stones between 2009 and 2012.
- Analysis of patient demographics, stone parameters, surgical approach, complications, and stone-free rates.
- Specific focus on retrograde intrarenal surgery (RIRS) outcomes.
Main Results:
- 19 infants underwent surgical procedures; 63.4% received retrograde endoscopic management initially.
- Open surgery was performed in 31.6% of cases, with a stone size cutoff of 10 mm for conversion.
- RIRS achieved an 84.6% stone clearance rate after repeat treatments, with a 15.7% major complication rate.
Conclusions:
- Retrograde intrarenal surgery (RIRS) is a safe and effective first-line treatment for renal stones in infants.
- RIRS is particularly beneficial for infants with cystinuria or complex stone locations (e.g., lower pole).
- Stone size, location, and obstruction significantly influence the decision for open surgical conversion.
Abstract:
Evaluating and treating renal stone disease in infants are technically challenging. In this study, we evaluated the surgical treatment of renal stones in children under 1 year of age. We retrospectively reviewed the records of patients under 1 year old who were treated with ESWL, endourological or open surgical procedures for renal stone disease between January, 2009 and December, 2012. The patients' age, gender, stone size, stone location and number, complications, stone-free status, and postoperative complications were recorded. 19 of 121 infants with a mean age of 10.2 ± 3.07 months were treated with surgical procedures. Six (75%) of eight cystinuria patients required a surgical intervention. Retrograde endoscopic management was performed in thirteen patients (63.4%) as an initial surgical approach. There were three major (15.7%) complications. The rate of open surgical procedures was 31.6% (6 of 19 infants). The cutoff value of stone size for open surgery was 10 mm. There was a significant relationship between the conversion to open procedures and stone size, stone location, and symptom presentation especially the presence of obstruction (p < 0.05). After repeated treatments, the stone clearance rate of RIRS reached 84.6%. Retrograde intrarenal surgery is an effective and safe treatment method for renal stones in infants and can be used as a first-line therapy in most patients under 1 year old. This is especially important if an associated ureteral stone or lower pole stone that requires treatment is present and for patients with cystinuria, which does not respond favorably to ESWL.
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