Pietropaolo A et al, 2017: Trends of intervention for paediatric stone disease over the last two decades (2000-2015): A systematic review of literature.
Pietropaolo A, Proietti S, Jones P, Rangarajan K, Aboumarzouk O, Giusti G, Somani BK.
University Hospital Southampton NHS Trust, Southampton, UK.
Raffaele Hospital, Ville Turro Division, Milan, Italy.
Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK.
Objective: To ascertain the publication trends of interventions for paediatric kidney stone disease (KSD) we conducted a systematic review of literature over the last 16 years.
Patients and methods: With a rise of paediatric KSD and related interventions, a systematic review using PubMed was done over the last 16 years for all published papers on 'Paediatric stone disease intervention - ureteroscopy (URS), shockwave lithotripsy (SWL), percutaneous nephrolithotomy (PCNL), open stone surgery, and laparoscopic stone surgery'. The search was limited to English language articles with a published abstract, whilst case reports, animal and laboratory studies, were excluded. We also analysed the data.
Results: During the last 16-years, 339 papers were published on paediatric stone disease interventionon PubMed. This included papers on URS (95), PCNL (97), SWL (102), open stone surgery (34) and laparoscopic stone surgery (11). During period-1 and period-2 there were 30 and 65 papers on URS, 16 and 81 papers on PCNL, 33 and 60 papers on SWL, nine and 25 papers on open surgery, respectively. When comparing the two periods, there were 92 published papers for all interventions in period-1 and this had risen almost threefold to 247 papers in period-2.
Conclusions: Our systematic review shows that intervention for KSD in the paediatric age group has risen over the last 8 years. Whilst URS, SWL, open surgery and laparoscopic surgery have all doubled, PCNL has risen fivefold reflecting an increase in the new minimally invasive PCNL techniques.
Arab J Urol. 2017 Nov 20;15(4):306-311. doi: 10.1016/j.aju.2017.10.006. eCollection 2017 Dec. Review. FREE ARTICLE
It is generally assumed that the number of publications on different methods for stone removal reflects how frequently the different methods are used. Accordingly there are two interesting notations in this review article. Firstly the dramatic increase in number of publications during 2015. Secondly it was surprising that SWL was found in so many paediatric publications between 2008 and 2013. The lack of information on the number of patients included in the various reports hampers solid conclusions and it can be assumed that the rise in PCNL reflects the technical development rather than describing to which extent children were treated with this specific method.
The great difference in choice of method for paediatric patients compared with adults is that whichever method that is applied, general anaesthesia is almost always necessary. Another point of interest for selection of method is the capacity of children’s ureters to pass also large quantities of fragments without the need of stenting.
According to EAU guidelines there is no doubt that staghorn stones should be removed percutaneously. My personal view is that ureteral stones favourably can be treated with SWL, thus leaving the ureter untouched irrespective of stone location. Whether LC-stones fulfil indications for SWL only if they have a size