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[Urolithiasis in children]
1Urologischen Abteilung, Ludwig Boltzmann-Institut für extrakorporale Lithotripsie und Endourologie, Wien.
Insights
Pediatric urolithiasis, though rare, is often linked to urinary tract infections. Extracorporeal shock wave lithotripsy (ESWL) is a primary treatment, with stone passage typically uncomplicated in children.
Area of Science:
- Pediatric Nephrology
- Urology
- Medical Technology
Context:
- Urolithiasis incidence in children is approximately 1%, often associated with urinary tract infections.
- Extracorporeal shock wave lithotripsy (ESWL) is the primary minimally invasive treatment for pediatric kidney stones, mirroring adult approaches.
- Pediatric urinary stone passage is generally less complicated than in adults, reducing the need for auxiliary measures.
Purpose:
- To outline the current understanding and management of urolithiasis in the pediatric population.
- To highlight the considerations for using ESWL in children, emphasizing device selection and safety.
- To detail essential preventive strategies, including antibiotic therapy and metabolic screening.
Summary:
- ESWL is the preferred treatment for childhood urolithiasis, with minimal complications and no evidence of soft tissue damage.
- Lithotriptors with small focal zones and ultrasound guidance are recommended for pediatric ESWL due to the developing anatomy.
- Simultaneous treatment of obstructive abnormalities and long-term preventive measures like antibiotic therapy and metabolic evaluation are crucial for managing pediatric kidney stones.
Impact:
- Provides guidance on the safe and effective application of ESWL in pediatric patients.
- Emphasizes the importance of tailored preventive strategies to reduce recurrence and avoid growth disturbances.
- Contributes to the optimal management of a rare but significant pediatric condition, improving patient outcomes.
Abstract:
Urolithiasis is rare in childhood (about 1%) and commonly associated with urinary tract infection. Like in adults ESWL is the minimally invasive treatment and therefore primary therapeutic approach. However, the passage of stone debris is less complicated than in adults and auxiliary measures are seldom needed. There is no evidence of soft tissue damage after ESWL, but in aspect of the growing organ lithotriptors with small focal zone and ultrasound location system are preferable. Obstructive anatomical abnormalities, if so, must be treated simultaneously. For prevention a strict antibiotic (longterm) therapy, according repeat antibiograms, and exclusion of metabolic disease are essential. Medication as well as special diets must be handled carefully or avoided as they might induce growth disorders.