Endourological management of pediatric stone disease: present status.
Publication/Presentation Date
1-1-2009
Abstract
PURPOSE: The incidence of nephrolithiasis in the pediatric population has been steadily increasing. The miniaturization of endoscopic instruments and improvement in imaging modalities have facilitated safe and effective endourological treatment in this patient population. We reviewed the current status of pediatric stone disease management.
MATERIALS AND METHODS: A comprehensive literature review was performed using MEDLINE/PubMed to evaluate the indications, techniques, complications and efficacy of endourological stone management in children.
RESULTS: In the 1980s shock wave lithotripsy revolutionized stone management in children, becoming the procedure of choice for treating upper tract calculi less than 1.5 cm. Percutaneous nephrolithotomy has replaced open surgical techniques for the treatment of stone burdens greater than 1.5 cm with efficacy and complication rates mirroring those in the adult population. However, at an increasing number of centers ureteroscopy is now being performed in cases that previously would have been treated with shock wave lithotripsy or percutaneous nephrolithotomy. Results from recent retrospective series demonstrate that stone-free rates and complication rates with ureteroscopy are comparable to percutaneous nephrolithotomy and shock wave lithotripsy. Although concerns remain with all endoscopic techniques in children regarding damage to the urinary tract and renal development, neither short-term nor long-term adverse effects have been consistently reported.
CONCLUSIONS: Shock wave lithotripsy, percutaneous nephrolithotomy and ureteroscopy are highly effective endourological techniques to treat stone disease in the pediatric population. A lack of prospective randomized trials comparing treatment modalities coupled with a vast disparity in the access to resources worldwide continues to individualize rather than standardize stone treatment in children.
Volume
181
Issue
1
First Page
17
Last Page
28
ISSN
1527-3792
Published In/Presented At
Smaldone, M. C., Corcoran, A. T., Docimo, S. G., & Ost, M. C. (2009). Endourological management of pediatric stone disease: present status. The Journal of urology, 181(1), 17–28. https://doi.org/10.1016/j.juro.2008.09.001
Disciplines
Medicine and Health Sciences
PubMedID
19012920
Department(s)
Department of Surgery
Document Type
Article