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Treatment of pediatric urolithiasis between 1984 and 1994
D J Lim1, R D Walker, P I Ellsworth
1Department of Surgery, University of Florida, Gainesville, USA.
Insights
New technologies reduced open surgery for pediatric urolithiasis (kidney stones in children). Comprehensive care addressing metabolic and structural issues is crucial for effective pediatric kidney stone management.
Area of Science:
- Pediatric Urology
- Nephrology
- Surgical Technology
Background:
- Pediatric urolithiasis presents unique management challenges.
- Understanding predisposing factors is key to comprehensive care.
Purpose of the Study:
- To evaluate the impact of new technologies on pediatric urolithiasis treatment.
- To assess changes in surgical intervention over a decade.
Main Methods:
- Retrospective review of 100 pediatric patients (age ≤18) treated for urolithiasis (1984-1994).
- Analysis of procedures, including shock wave lithotripsy, ureteroscopy, and open surgery.
- Metabolic evaluation via 24-hour urine collections in 37 patients.
Main Results:
- Fewer patients required open surgery compared to traditional methods.
- Shock wave lithotripsy was the most common procedure (42 cases).
- Metabolic abnormalities (e.g., hypercalciuria) and structural anomalies were identified in a significant proportion of patients.
Conclusions:
- Advanced technologies have decreased the need for open surgery in pediatric urolithiasis.
- A holistic approach, addressing both stone treatment and underlying causes (metabolic, structural), is essential for optimal outcomes in children.
Purpose:
We report our experience with the management of pediatric urolithiasis during a 10-year period. Our aim was to assess the impact of new technology in the treatment of pediatric urolithiasis.
Materials And Methods:
We retrospectively reviewed the records of all patients up to age 18 years in whom urolithiasis was treated from 1984 to 1994. In 37 cases 24-hour urine collections were available for metabolic evaluation.
Results:
A total of 100 pediatric patients was treated for urolithiasis. Mean followup was 36 months. A total of 79 patients underwent 115 procedures for symptomatic urolithiasis and 21 were treated nonoperatively. In 42 patients structural anomalies of the urinary tract required additional management. Metabolic abnormalities in 48 patients included hypercalciuria in 19, defined as greater than 4 mg./kg./24 hours calcium by 24-hour urine collection. Only 24 of the 100 patients had no identifiable predisposing factors. Procedures included shock wave lithotripsy in 42 cases, basket extraction with or without ureteroscopy in 20, percutaneous nephrostolithotomy in 11 and litholapaxy in 12. Open surgery included cystolithotomy in 10 cases and other forms of open lithotomy in 15. Thus, open surgical removal was necessary in 1 of 5 cases.
Conclusions:
Compared to the traditional mode of stone treatment, fewer patients required open surgery. Our results indicate that a comprehensive approach to the care of pediatric patients with urolithiasis requires attention to metabolic and structural abnormalities.