[Current aspects in pediatric urolithiasis treatment]

Area of Science:

• Pediatric Urology
• Nephrology
• Surgical Technology

Background:

• Urolithiasis (urinary stones) is significantly less common in children than adults, accounting for 1-2% of all cases.
• While adult treatment modalities are applicable, pediatric anatomical and functional peculiarities necessitate distinct therapeutic indications.
• Asymptomatic renal stones in children are typically managed conservatively with observation due to a higher likelihood of spontaneous passage compared to adults.

Purpose of the Study:

• To outline the current therapeutic approaches for pediatric urolithiasis.
• To highlight the differential indications for various treatment modalities in children.
• To emphasize the safety and efficacy of minimally invasive techniques in pediatric stone management.

Main Methods:

• Review of established and emerging treatment modalities for pediatric urolithiasis.
• Analysis of factors influencing treatment selection, including stone size, location, and composition.
• Discussion of surgical interventions, including extracorporeal shock wave lithotripsy, endoscopic techniques, percutaneous nephrolithotomy (PCNL), ureteroscopy, and open/laparoscopic surgery.

Main Results:

• Spontaneous stone passage is more frequent in children than adults.
• Noninvasive and minimally invasive techniques are preferred when spontaneous passage does not occur.
• Extracorporeal shock wave lithotripsy is often the primary choice; endoscopic methods are safe even in infants.
• Percutaneous nephrolithotomy (PCNL) is indicated for large or specific stone compositions (cystine, whewellite); ureteroscopy is preferred for distal ureteral stones.
• Laparoscopic and open surgeries are reserved for complex cases or associated pathologies.
• Transurethral or suprapubic lithotripsy is used for bladder calculi.

Conclusions:

• Treatment strategies for pediatric urolithiasis must account for the unique characteristics of the pediatric population.
• Minimally invasive approaches, including extracorporeal shock wave lithotripsy and endoscopic procedures, are highly effective and safe for pediatric urinary stones.
• Percutaneous nephrolithotomy (PCNL) and ureteroscopy represent key interventions for specific stone burdens and locations, while open surgery is rarely necessary.