Granberg et al, 2012: Urolithiasis in children: surgical approach
Granberg CF, Baker LA
Department of Urology, University of Texas Southwestern Medical Center, Children's Medical Center at Dallas, Dallas, TX 75207, USA
Over the past 3 decades, minimally invasive stone surgery has completely overtaken open surgical approaches to upper tract pediatric urolithiasis. Progressing from least to most minimally invasive, extracorporeal shock wave lithotripsy, ureteroscopy, and percutaneous nephrolithotomy are the surgical methods of today for kidney and ureteral stones. The choice of treatment modality is individualized in children, considering patient age, stone size, number, location, and anatomic and clinical contributing factors. The purpose of this article is to review these techniques for pediatric upper urinary tract stones and summarize outcomes and complications.
Copyright © 2012 Elsevier Inc. All rights reserved.
Pediatr Clin North Am. 2012 Aug;59(4):897-908. doi: 10.1016/j.pcl.2012.05.019. Epub 2012 Jun 22
PMID:22857836[PubMed - indexed for MEDLINE]
Given the small dimension of the kidneys and ureters in children, the authors conclude in this review article that ESWL should be the first-line treatment. I fully agree with that statement. It is my own experience that in contrast to adults the need of ureteral stenting is in most cases unnecessary, also when large stones are treated. When selecting patients for ESWL it might be noted that even cystine (not cysteine) stones usually can be disintegrated rather easily and I have personally not encountered any brushite stone in a child. Are they commonly seen?
It is my impression after reading this chapter on ESWL that several recommendations are based on adult rather than on paediatric experience. It would for instance have been of value to show a child in the lithotripter rather than an adult man, because in several lithotripters it might be associated with difficulties to place a child in a safe and appropriate position. Advice in that regard would have been of great value.