Endourological management of pediatric urolithiasis in Northeast India
DOI:
https://doi.org/10.18203/2320-6012.ijrms20210881Keywords:
Pediatric urolithiasis, PCNL, ESWLAbstract
Background: Urolithiasis affects between 5-10% of the population during their lifetime, 2-3% of them are children. In the last decade, technological advancement and miniaturization of instruments has changed the management of pediatric urinary-stone disease. Extracorporeal shockwave lithotripsy (ESWL) has been preferred method of management of pediatric stone disease, whereas the endoscopic approach is limited to a few centers.
Methods: This retrospective study was conducted among the pediatric patients (6-15 years) presenting with urolithiasis during 1st January 2017 to 31st December 2019 to the department of urology, Dispur hospital Pvt. Ltd., Assam. Only confirmed cases of pediatric urolithiasis were included in this study. Medical records were reviewed for clinical and laboratory data including gender, age at diagnosis, clinical presentation, presence of urinary tract anomalies, and urinary tract infections (UTI) in the form of urinalysis, urine culture and complete blood count. Metabolic evaluation was advised in all children. Finally, a total of 100 pediatric urolithiasis cases were included in this study.
Results: ESWL was performed in 28 children. The stone-free rate was 85.7%. The total number of shocks per treatment ranged from 1000 to 2000. A total of 10 percutaneous nephrolithotomy (PCNLs) were done with complete stone clearance in 83.33%. In the URS group, urethroscopy was successful in 20 cases (75%). Cystolithotripsy was done in 08 cases with 100% clearance rate. 30 patients were managed conservatively.
Conclusions: ESWL is highly effective in children for small stone burden. Early metabolic evaluation and treatment may prevent further renal damage and recurrence.
References
Mahmud M, Zafar Z. Percutaneous nephrolithotomy in children before school age: Experience of a Pakistani centre. BJU Int. 2004;94:1352-4.
Coward RJ, Peters CJ, Duffy PG, Kellet MJ, Choong S, Van't Hoff WG. Epidemiology of pediatric renal stone disease in the UK. Arch Dis Child. 2003;88:962-5.
Erbagci A, Erbagci AB, Yilmaz M, Yagci F, Tarakcioglu M, Yurtseven C. Pediatric urolithiasis-evaluation of risk factors in 95 children. Scand J Urol Nephrol. 2003;37(2):129-33.
López M, Hoppe B. History, epidemiology and regional diversities of urolithiasis. Pediatric nephrology. 2010;25(1):49-59.
Segura JW, Preminger GM, Assimos DG. Nephrolithiasis Clinical Guidelines Panel summary report on the management of staghorn calculi. J Urol. 1994;151:1648.
Shukla AR, Hoover DL, Homsy YL, Perlman S, Schurman S, Reisman EM. Urolithiasis in the low-birth-weight infant: The role and efficacy of extracorporeal shock wave lithotripsy. J Urol. 2001;165:2320.
Schultz-Lampel D, Lampel A. The surgical management of stone in children. BJU Int. 2001;87:732
Tasian GE, Copelovitch L. Evaluation and medical management of kidney stones in children. The Journal of urology. 2014;192(5):1329-36.
Fragoso AC, Valla JS, Steyaert H, Arnaud P, Esposito C, Estevão-Costa J. Minimal access surgery in the management of pediatric urolithiasis. J pediatric urol. 2009;5(1):42-6.
Robertson WG, Whitfield H, Unwin RJ, Mansell MA, Neild GH. Possible causes of the changing pattern of the age of onset of urinary stone disease in the UK. Urolithiasis, Rodgers AL, Hess B, Khan SR, Preminger GM, Eds. 2000.
Djelloul Z, Djelloul A, Bedjaoui A, Kaid-Omar Z, Attar A, Daudon M et al. Urinary stones in Western Algeria: study of the composition of 1,354 urinary stones in relation to their anatomical site and the age and gender of the patients. Progres en Urologie: J L'association Francaise D'urologie et de la Societe Francaise D'urologie. 2006;16(3):328-35.
Sarica K. Pediatric urolithiasis: etiology, specific pathogenesis and medical treatment. Urological res. 2006;34(2):96-101.
Sarica K. Medical aspect and minimal invasive treatment of urinary stones in children. Archivio italiano di urologia andrologia. 2008;80(2):43.
Sayasone S, Odermatt P, Khammanivong K, Phomluangsyl S, Vinhl CV, Thin HM et al. Bladder stones in childhood: a descriptive study in a rural setting in Saravan Province, Lao PDR. Southeast Asian J Trop Med Public Health. 2004;35(2):50-2.
Aldaqadossi HA, Shaker H, Saifelnasr M, Gaber M. Efficacy and safety of tamsulosin as a medical expulsive therapy for stones in children. Arab j urol. 2015;13(2):107-11.
Mokhless I, Zahran AR, Youssif M, Fahmy A. Tamsulosin for the management of distal ureteral stones in children: a prospective randomized study. J pediat urol. 2012;8(5):544-8.
Glina FP, Castro PM, Monteiro GG, Del Guerra GC, Glina S, Mazzurana M et al. The use of alpha-1 adrenergic blockers in children with distal ureterolithiasis: a systematic review and meta-analysis. Int Braz j urol. 2015;41(6):1049-57.
Velázquez N, Zapata D, Wang HH, Wiener JS, Lipkin ME, Routh JC. Medical expulsive therapy for pediatric urolithiasis: Systematic review and meta-analysis. J pediatr urol. 2015;11(6):321-7.
Ishii H, Griffin S, Somani BK. Ureteroscopy for stone disease in the paediatric population: a systematic review. BJU int. 2015;115(6):867-73.
Taguchi K, Cho SY, Ng AC, Usawachintachit M, Tan YK, Deng YL et al. The Urological Association of Asia clinical guideline for urinary stone disease. Int J Urol. 2019;26(7):688-709.
