Grivas N. et al., 2020: Imaging modalities and treatment of paediatric upper tract urolithiasis: A systematic review and update on behalf of the EAU urolithiasis guidelines panel
Grivas N, Thomas K, Drake T, Donaldson J, Neisius A, Petřík A, Ruhayel Y, Seitz C, Türk C, Skolarikos A.
Department of Urology, G.Hatzikosta General Hospital, Ioannina, Greece; Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands.
Department of Urology, Guy's and St Thomas' NHS Foundation Trust, The Stone Unit, London, UK.
Department of Urology, Southmead Hospital, Bristol, UK.
Department of Urology, Aberdeen Royal Infirmary, Aberdeen, Scotland, UK.
Department of Urology, Hospital of the Brothers of Mercy Trier, Johannes Gutenberg University Mainz, Trier, Germany.
Department of Urology, Region Hospital, Ceske Budejovice, Czech Republic; Dept. of Urology, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic.
Department of Urology, Skåne University Hospital, Malmö, Sweden.
Department of Urology, Vienna General Hospital, Medical University of Vienna, Vienna, Austria.
Department of Urology, Hospital of the Sisters of Charity, Vienna, Austria; Urologische Praxis Mit Steinzentrum, Vienna, Austria.
Second Department of Urology, Sismanoglio Hospital, National and Kapodistrian University of Athens, Athens, Greece.
Background: Prompt diagnosis and treatment of paediatric urolithiasis are required to avoid long term sequelae of renal damage.
Objective: To systematically review the literature regarding the diagnostic imaging modalities and treatment approaches for paediatric urolithiasis.
Study design: PubMed, Science Direct, Scopus and Web of Science were systematically searched from January 1980-January 2019. 76 full-text articles were included.
Results: Ultrasound and Kidney-Ureter-Bladder radiography are the baseline diagnostic examinations. Non-contrast Computed Tomography (CT) is the second line choice with high sensitivity (97-100%) and specificity (96-100%). Magnetic Resonance Urography accounts only for 2% of pediatric stone imaging studies. Expectant management for single, asymptomatic lower pole renal stones is an acceptable initial approach, especially in patients with non-struvite, non-cystine stones<7 mm. Limited studies exist on medical expulsive therapy as off-label treatment. Extracorporeal shock wave lithotripsy (SWL) is the first-line treatment with overall stone free rates (SFRs) of 70-90%, retreatment rates 4-50% and complication rates up to 15%. Semi-rigid ureteroscopy is effective with SFRs of 81-98%, re-treatment rates of 6.3-10% and complication rates of 1.9-23%. Flexible ureteroscopy has shown SFRs of 76-100%, retreatment rates of 0-19% and complication rates of 0-28%. SFRs after first and second-look percutaneous nephrolithotomy (PNL) are 70.1-97.3% and 84.6-97.5%, respectively with an overall complication rate of 20%. Open surgery is seldom used, while laparoscopy is effective for stones refractory to SWL and PNL. Limited data exist for robot-assisted management.
Conclusions: In the initial assessment of paediatric urolithiasis, US is recommended as first imaging modality, while non-contrast CT is the second option. SWL is recommended as first line treatment for renal stones <20 mm and for ureteral stones<10 mm. Ureteroscopy is a feasible alternative both for ureteral stones not amenable to SWL as well as for renal stones <20 mm (using flexible). PNL is recommended for renal stones >20 mm.
J Pediatr Urol. 2020 Jul 4:S1477-5131(20)30413-7. doi: 10.1016/j.jpurol.2020.07.003. Online ahead of print. PMID: 32739360 Review.