Peng T. et al., 2022: Minimally invasive surgery for pediatric renal and ureteric stones: A therapeutic update.
Peng T, Zhong H, Hu B, Zhao S.
Department of Pediatric Surgery, Huizhou Central People's Hospital, Huizhou, China.
Department of Urology, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, China.
The incidence of pediatric urolithiasis (PU) is growing worldwide. The corresponding therapeutic methods have become a research hot spot in pediatric urology. PU has the characteristics of abnormal metabolism, easy recurrence, and immature urinary system development, which make its treatment different from that of adults. Pediatric urologists should select the optimal treatment modality to completely remove the stones to prevent recurrence. Currently, the curative treatments of PU include extracorporeal shock wave lithotripsy (ESWL), ureteroscopy, retrograde intrarenal surgery, percutaneous nephrolithotomy (PCNL), laparoscopic, robot-assisted laparoscopic, and open surgery. This review aims to conduct a therapeutic update on the surgical interventions of both pediatric renal and ureteric stones. It accentuates that pediatric surgeons or urologists should bear in mind the pros and cons of various minimally invasive surgical treatments under different conditions. In the future, the treatment of PU will be more refined due to the advancement of technology and the development of surgical instruments. However, a comprehensive understanding of the affected factors should be taken into account by pediatric urologists to select the most beneficial treatment plan for individual children to achieve precise treatment.
Front Pediatr. 2022 Aug 18;10:902573. doi: 10.3389/fped.2022.902573. eCollection 2022. PMID: 36061394 Review. FREE ARTICLE
It is both noteworthy and interesting to see that in pediatric stone treatment, despite the current enthusiasm for endoscopic procedures, SWL still is considered as the first line treatment modality.
The following indications for SWL are worthwhile to observe:
Renal stones 10 mm irrespective of HU.
Non-lower calyx stones 10-20 mm with HU 750.
Upper ureteral stones 15 mm and mid/distal uretral stones 20 mm (> 300 mm2).
In terms of RIRS, favorable results have been reported, but for this treatment modality it is necessary to consider the narrow ureter in children.
For distal stones opment of stone removal is children’s safety in terms of reduced radiation. Moreover, the goal should be ONE treatment session only!