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Urinary tract anomalies and their role in pediatric stone formation
Rifat Burak Ergül1,2,3, M Fırat Ozervarli1, Kazım Can Oba1
1Department of Urology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey.
Insights
Congenital urinary tract anomalies increase pediatric stone risk via obstruction and stasis. These conditions, including ureteropelvic junction obstruction (UPJO), often involve metabolic issues, necessitating further study for optimal management.
Area of Science:
- Pediatric Nephrology
- Urology
- Congenital Abnormalities
Background:
- Pediatric nephrolithiasis is increasingly recognized.
- Congenital urinary tract anomalies are potential contributors to stone formation.
Purpose of the Study:
- To evaluate the role of congenital urinary tract anomalies in pediatric nephrolithiasis pathogenesis.
- To elucidate how structural abnormalities contribute to urinary stasis, infection, and stone formation.
Main Methods:
- Narrative literature review of peer-reviewed studies, case series, and reports.
- Analysis of pathophysiological mechanisms, diagnostics, and treatment strategies.
Main Results:
- Anomalies like UPJO, horseshoe kidney, and ectopic kidneys are linked to increased stone risk due to stasis and infection.
- UPJO patients frequently have metabolic abnormalities (up to 76%).
- Exstrophy-epispadias complex and bladder augmentation lead to bladder stones in up to 22%.
Conclusions:
- Congenital anomalies may elevate pediatric stone risk through obstruction, stasis, and metabolic issues.
- Further prospective studies are required to confirm causality and refine management.
Purpose:
This review aims to evaluate the role of congenital urinary tract anomalies in the pathogenesis of pediatric nephrolithiasis. By examining specific structural abnormalities such as ureteropelvic junction obstruction (UPJO), horseshoe kidney, ectopic kidney, exstrophy-epispadias complex, and ureterocele, we aim to elucidate how these anomalies contribute to urinary stasis, infection, metabolic disturbances, and ultimately, stone formation in children.
Methods:
A narrative literature review was conducted focusing on congenital anomalies of the urinary tract and their association with pediatric stone formation. Relevant studies, case series, and case reports published in peer-reviewed journals were analyzed to explore the pathophysiological mechanisms, diagnostic approaches, and treatment strategies employed in affected pediatric populations.
Results:
Urinary tract anomalies such as UPJO, horseshoe kidney, and ectopic kidneys were frequently associated with increased risk of stone formation, primarily due to urinary stasis and infection. In UPJO, a significant proportion of patients (up to 76%) also exhibited underlying metabolic abnormalities. Combined surgical approaches, such as robotic or laparoscopic pyeloplasty with simultaneous stone removal, demonstrated favorable outcomes with low complication rates. In children with exstrophy-epispadias complex and bladder augmentation, bladder stones developed in up to 22% of cases, regardless of the bowel segment used. Ureteroceles, although rare in children, can also harbor stones and pose diagnostic challenges. Minimally invasive interventions have shown promising results in these scenarios.
Conclusions:
Congenital urinary tract anomalies may increase the risk of pediatric stone formation by contributing to urinary obstruction, stasis, and metabolic derangements. While existing evidence supports this association, further prospective studies are needed to better define causality and optimize management strategies in this unique patient population.
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