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Strohmaier WL., 2020: [Current aspects in pediatric urolithiasis treatment].

Strohmaier WL.
Regiomed-Klinikum Coburg, Regiomed Medical School Coburg, Universität Split, Ketschendorfer Str. 33, 96450, Coburg, Deutschland.

Abstract

Compared with adults, urolithiasis is quite rare in children (1-2% of all urinary stones occur during childhood). In principle, all therapy modalities for adults can also be used in children. However, due to some anatomic and functional peculiarities in children, the differential indication for the various treatment modalities differ. As a rule, asymptomatic renal stones are not treated but observed. More urinary stones pass spontaneously in children compared with adults. If spontaneous passage is not possible or does not occur, noninvasive and minimally invasive techniques are indicated. Extracorporeal shock wave lithotripsy is the therapy of choice in most instances. Today, endoscopic techniques, however, can be safely used even in very small infants. For larger renal stones and those consisting of cysteine or whewellite, percutaneous nephrolithotomy (PCNL) is the therapy of choice, and for distal ureteral stones ureteroscopy is the method of choice. Laparoscopic and open surgery are reserved for very rare cases, especially with concomitant pathologies. Bladder calculi are treated by transurethral or suprapubic lithotripsy.
Urologe A. 2020 Mar;59(3):289-293. doi: 10.1007/s00120-020-01132-w.

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Comments 1

Hans-Göran Tiselius on Thursday, May 28 2020 08:30

Most urologists have limited experience of treating children with stones. For readers who can understand the German language, this brief summary therefore might be helpful.

The bottom-line is that stone-removal should be carried out only for symptomatic stones. (I am uncertain whether such a rule also is applicable to adults?) All procedures used for adults also can be used for children although instrument adaptation will be necessary. It is emphasized that the ease by means of which stones up to a size of at least 4 mm can pass, invites to SWL.

The author suggests exclusion of cystine and COM stones from SWL. My own experience, however, is that these stones also can be good alternatives for SWL. The reason might be that the history of stone formation usually is short and the stones not as resistant to shockwaves as stones that have resided in the urinary tract for longer periods. SWL accordingly can be considered as first line treatment in children; the obstacle is the need of anaesthesia.
MET is seldom used in children, but metabolic risk evaluation is essential.

It is important that uric acid stones are best treated with oral chemolysis.

Most urologists have limited experience of treating children with stones. For readers who can understand the German language, this brief summary therefore might be helpful. The bottom-line is that stone-removal should be carried out only for symptomatic stones. (I am uncertain whether such a rule also is applicable to adults?) All procedures used for adults also can be used for children although instrument adaptation will be necessary. It is emphasized that the ease by means of which stones up to a size of at least 4 mm can pass, invites to SWL. The author suggests exclusion of cystine and COM stones from SWL. My own experience, however, is that these stones also can be good alternatives for SWL. The reason might be that the history of stone formation usually is short and the stones not as resistant to shockwaves as stones that have resided in the urinary tract for longer periods. SWL accordingly can be considered as first line treatment in children; the obstacle is the need of anaesthesia. MET is seldom used in children, but metabolic risk evaluation is essential. It is important that uric acid stones are best treated with oral chemolysis.
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Thursday, August 13 2020

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