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The role of surgery and lithotripsy in childhood urolithiasis
J O Pelzer1, E Leumann, M G Schwöbel
1Department of Pediatric Surgery, University Children's Hospital, Zurich, Switzerland.
Insights
Extracorporeal shock-wave lithotripsy (ESWL) is increasingly important for treating pediatric urolithiasis. While surgery remains necessary for congenital malformations, ESWL is the preferred method for other causes like infections and hypercalciuria.
Area of Science:
- Pediatric Urology
- Nephrology
- Surgical Innovation
Background:
- Urolithiasis in infants and children presents diverse etiologies.
- Treatment options have evolved, with extracorporeal shock-wave lithotripsy (ESWL) becoming available.
- Understanding the efficacy of different interventions is crucial for pediatric stone management.
Purpose of the Study:
- To evaluate the outcomes of surgical interventions and ESWL for pediatric urolithiasis.
- To compare the effectiveness of different treatment modalities based on stone etiology.
- To assess the safety and applicability of ESWL in pediatric patients.
Main Methods:
- Retrospective analysis of 36 interventions in 32 pediatric patients (1982-1993).
- Categorization of urolithiasis causes: congenital malformations, recurrent UTIs, previous operations, hypercalciuria, and unknown.
- Comparison of open surgery, ESWL, and endoscopic extraction for calculus removal.
Main Results:
- 26 calculi removed surgically, 13 by ESWL, and 1 endoscopically.
- Congenital malformations and post-operative conditions were treated surgically.
- ESWL was the primary choice for post-infectious, idiopathic, and hypercalciuric calculi after 1988.
- No complications reported for either ESWL or open surgery.
Conclusions:
- ESWL is gaining importance as a treatment for pediatric urolithiasis.
- Open surgery remains essential for calculi associated with congenital malformations and post-operative conditions.
- ESWL is the preferred treatment for other etiologies in pediatric stone disease.
Abstract:
From 1982 through 1993 36 interventions in 32 infants and children with urolithiasis have been performed in our department. There were 22 boys and 10 girls. The main cause for the interventions have been congenital malformations in 9, followed by recurrent urinary tract infections in 6, previous operations in 5 and hypercalciuria in 5 patients. In 7 children the cause of the urolithiasis remained unknown. As a therapeutic option extracorporeal shock-wave lithotripsy (ESWL) was available after 1988. The malformations as well as the postoperative conditions have been corrected surgically and the calculi were removed at the same time. For post-infectious, idiopathic or hypercalciuric calculi ESWL was used in the majority of patients after 1988. Therefore a total of 26 calculi were removed by operation and 13 by ESWL. Only 1 calculus was extracted endoscopically. There were no complications either after ESWL or after open surgery. Our results show that ESWL gains more and more importance in infants and children. Calculi in congenital malformations or as result of operations are still removed by open surgery. In the other cases ESWL is the method of choice.