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Endoscopic treatment of pediatric urolithiasis
E A Kurzrock1, J L Huffman, B E Hardy
1Department of Urology, University of Southern California School of Medicine, Children's Hospital, Los Angeles, USA.
Insights
Endourologic surgery offers a safe and effective alternative to open surgery for pediatric urolithiasis. This minimally invasive approach successfully treated kidney stones in children, reducing hospital stays and complications.
Area of Science:
- Pediatric Urology
- Endourology
- Nephrolithiasis Management
Background:
- Pediatric urolithiasis treatment has lagged behind adult advancements.
- Open surgery remains common despite less invasive options.
- Endourologic techniques offer potential benefits for children with kidney stones.
Purpose of the Study:
- To evaluate the indications, efficacy, and complications of endourologic surgery for pediatric urolithiasis.
- To assess the outcomes of minimally invasive stone removal in children.
- To compare endourologic outcomes with traditional surgical methods.
Main Methods:
- Retrospective review of 53 children with upper tract calculi.
- Treatment of 25 children not suitable for extracorporeal shock wave lithotripsy.
- Use of miniature ureteroscopes with lasertripsy and percutaneous nephrolithotomy.
Main Results:
- All 25 treated patients were rendered stone-free.
- Ureteral dilation and postoperative stenting were minimal (6% and 29%, respectively).
- Percutaneous treatment of large stones showed no transfusions or complications.
Conclusions:
- Endourologic surgery is effective and safe for pediatric urolithiasis.
- Minimally invasive techniques can replace open surgery in children.
- Management requires experienced endourologists and diverse treatment modalities.
Abstract:
Children have been slow to benefit from the improvements in stone therapy. Despite the success of less invasive techniques, open surgery for pediatric urolithiasis is still commonly practiced. The authors' goal was to evaluate the indications, efficacy, and complications of endourologic surgery in the treatment of pediatric urolithiasis. They reviewed the treatment of 53 children who had upper tract calculi. Open nephro- and ureterolithotomy were avoided in all cases. The management of 25 children whose stones were not amenable to extracorporeal shock wave lithotriopsy is presented. Seventeen children (19 stones) were treated with miniature ureteroscopes and lasertripsy. Only one (6%) of the patients required ureteral dilation, and only five (29%) needed a postoperative internal stent. Eight children with large renal calculi were treated percutaneously, without transfusion, complication, or evidence of persistent renal damage. All 25 patients were rendered stone-free. The hospital stay was shorter and secondary procedures were less common in comparison to other series of endoscopic lithotripsy. With significant experience in adult endourology and proper instrumentation, one can apply the same techniques to children and achieve equal if not greater benefit. Nephrolithiasis in children is uncommon and should be managed in an institution where endourologists and multiple treatment modalities are available.