S Güven et al., 2024: Consensus statement addressing controversies and guidelines on pediatric urolithiasis
S Güven 1, T Tokas 2, A Tozsin 3, B Haid 4, T S Lendvay 5, S Silay 6, V C Mohan 7, J R Cansino 8, S Saulat 9, M Straub 10, A Bujons Tur 11, B Akgül 3, J Samotyjek 12, L Lusuardi 13, S Ferretti 14, O F Cavdar 15, G Ortner 16, S Sultan 17, S Choong 18, S Micali 14, I Saltirov 19, A Sezer 20, C Netsch 21, E de Lorenzis 22, O O Cakir 23, G Zeng 24, A S Gozen 25, G Bianchi 14, B Jurkiewicz 12, T Knoll 26, J Rassweiler 27, K Ahmed 23 28 29, K Sarica 30 31
1Department of Urology, Necmettin Erbakan University Meram School of Medicine, Konya, Turkey.
2Department of Urology, University General Hospital of Heraklion, Athens, Greece.
3Department of Urology, Trakya University School of Medicine Hospital, Edirne, Turkey.
4Ordensklinikum Linz, Barmherzige Scwestern Hospital, Linz, Austria.
5Department of Urology, University of Washington, Seattle Children's Hospital, Seattle, WA, USA.
6Istanbul Medipol University, Istanbul, Turkey.
7Preeti Urology Hospital, Hyderabad, Telangana, India.
8Hospital Universitario La Paz, Madrid, Spain.
9Department of Urology, Tabba Kidney Institute, Karachi, Pakistan.
10Department of Urology, Technical University Munich, Munich, Germany.
11Urology Department, Fundación Puigvert, Universidad Autónoma de Barcelona, Barcelona, Spain.
12Pediatric Surgery and Urology Clinic CMKP in Dziekanów Leśny, Dziekanów Leśny, Poland.
13Department of Urology, Paracelsus Medical University Salzburg University Hospital, Urology, Salzburg, Austria.
14Department of Urology, University of Modena and Reggio Emilia, Modena, Italy.
15Department of Urology, Necmettin Erbakan University Meram School of Medicine, Konya, Turkey.
16Department of Urology, General Hospital Hall I.T, Tirol, Austria.
17Department of Urology, Menoufia University Hospitals, Shebeen El Kom, Egypt.
18Institute of Urology, University College Hospital, London, UK.
19Department of Urology and Nephrology at Military Medical Academy, Sofia, Bulgaria.
20Pediatric Urology Clinic, Konya City Hospital, Konya, Turkey.
21Asklepios Klinik BarmbekAbteilung Für Urologie, Hamburg, Germany.
22Department of Urology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
23King's College London, Guy's and St. Thomas' NHS Foundation Trust, King's Health Partners, London, UK.
24Department of Urology and Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
25Department of Urology, Medius Clinic, Ostfildern, Germany.
26Klinikum Sindelfingen-Boeblingen, Sindelfingen, Germany.
27Department of Urology and Andrology, Danube Private University, Krems, Austria.
28Sheikh Khalifa Medical City, Abu Dhabi, UAE.
29Khalifa University, Abu Dhabi, UAE.
30Sancaktepe Sehit Prof. Dr. Ilhan Varank Research and Training Hospital, Istanbul, Turkey.
31Department of Urology, Biruni University Medical School, Istanbul, Turkey.
Abstract
Purpose: We aimed to investigate controversial pediatric urolithiasis issues systematically, integrating expert consensus and comprehensive guidelines reviews.
Methods: Two semi-structured online focus group meetings were conducted to discuss the study's need and content, review current literature, and prepare the initial survey. Data were collected through surveys and focus group discussions. Existing guidelines were reviewed, and a second survey was conducted using the Delphi method to validate findings and facilitate consensus. The primary outcome measures investigated controversial issues, integrating expert consensus and guideline reviews.
Results: Experts from 15 countries participated, including 20 with 16+ years of experience, 2 with 11-15 years, and 4 with 6-10 years. The initial survey identified nine main themes, emphasizing the need for standardized diagnostic and treatment protocols and tailored treatments. Inter-rater reliability was high, with controversies in treatment approaches (score 4.6, 92% agreement), follow-up protocols (score 4.8, 100% agreement), and diagnostic criteria (score 4.6, 92% agreement). The second survey underscored the critical need for consensus on identification, diagnostic criteria (score 4.6, 92% agreement), and standardized follow-up protocols (score 4.8, 100% agreement).
Conclusion: The importance of personalized treatment in pediatric urolithiasis is clear. Prioritizing low-radiation diagnostic tools, effectively managing residual stone fragments, and standardized follow-up protocols are crucial for improving patient outcomes. Integrating new technologies while ensuring safety and reliability is also essential. Harmonizing guidelines across regions can provide consistent and effective management. Future efforts should focus on collaborative research, specialized training, and the integration of new technologies in treatment protocols.
World J Urol. 2024 Aug 7;42(1):473. doi: 10.1007/s00345-024-05161-4. PMID: 39110242
• PMCID: PMC11306500 FREE PMC ARTICLE
Comments 1
The 33 authors of this report scrutinized the existing guidelines on pediatric urolithiasis with the aim of formulating the best principles for treating children with urolithiasis.
The following guidelines were included:
EAU pediatric urology guidelines
AUA kidney stone guidelines
IAU guidelines
UAA clinical guidelines for urinary stone disease to obtain the
NICE guidelines
Differences and similarities are summarized in Tables and the areas in which there is need of further research to obtain the goal of optimal diagnosis, treatment and follow-up are emphasized. The basic conclusion was that there was a need for standardized protocols. Despite considerable progress in minimally invasive surgical techniques, there still is a lack of consensus on how to deal with stone problems.
One fundamental conclusion is that radiation exposure must be minimized!
Key areas that are specifically mentioned are standardized diagnostic tools and treatment protocols as well as principles for metabolic evaluation and risk/recurrence prevention. They also emphasized that that medical treatment needs to be adapted to children’s pharmacokinetics, a factor that in the reviewer’s opinion has been seriously neglected.
One point that is specifically discussed is how to deal with residual fragments. It is stated that the recurrence risk of residual fragments is higher among children. Whether this statement is generally true or not, it is important with careful follow-up. The use of MET is discussed. The reviewer’s experience is that minor residual fragments have a greater chance of spontaneous passage given the activity and mobility of children.
The bottom-line of this article, however, is that it is important with personalized treatment of the pediatric population.
Hans-Göran Tiselius