Gnessin E et al, 2012: Current management of paediatric urolithiasis
Gnessin E, Chertin L, Chertin B
Department of Urology, Faculty of Medical Science, Shaare Zedek Medical Center, Hebrew University, Jerusalem, Israel
We aimed to review a current management of paediatric nephrolithiasis. The current literature, including our own experience on the treatment of paediatric nephrolithiasis was reviewed by MEDLINE/PubMed search. We have used in our search following keywords: urolithiasis, nephrolithiasis, paediatrics, surgical treatment, conservative management, ESWL, ureteroscopy, and open renal surgery. The search was limited to the English language literature during the period of time from 1990 to 2011. All papers were reviewed independently by all co-authors and only the manuscripts directly related to the reviewed subjects were included into the current review. Due to the high incidence of predisposing factors for urolithiasis in children and high stone recurrence rates, every child with urinary stone should be given a complete metabolic evaluation. Most stones in children can be managed by ESWL and endoscopic techniques. Paediatric stone disease is an important clinical problem in paediatric urology practice. Because of its recurrent nature, every effort should be made to discover the underlying metabolic abnormality so that it can be treated appropriately. Obtaining a stone-free state with interventional management and close follow-up are of utmost importance.
Pediatr Surg Int. 2012 Jul;28(7):659-65. doi: 10.1007/s00383-012-3096-4. Epub 2012 Apr 28
PMID :22543474 [PubMed - in process]
This is a review article on the management of stones in children based on literature reports. It is concluded that ESWL by most authors is considered to be the treatment of choice at least for stones with a diameter up to 20 mm. But also larger stones can be considered for ESWL. There is no need for stenting because of the easier passage of fragments through the pediatric ureter compared with the situation in adults. A stone-free rate of 95% was noted in children compared with 79% in a matched adult population.
One surprising statement is that whereas anesthesia or sedation was considered necessary in non-cooperative children, ESWL in older children can be completed without medication. That conclusion is most likely lithotripter dependant and is not in agreement with my own experience in which all children need anesthesia.