Experience of treating calculi of the urinary tract in children
DOI:
https://doi.org/10.15574/PS.2024.83.65Keywords:
urolithiasis, extracorporeal shock wave lithotripsy, minipercutaneous nephrolithotripsy, contact lithotripsy, calculus, childrenAbstract
Aim - to analyze the treatment of children with urolithiasis (urolithiasis), taking into account the location of stones in the urinary tract, their size and density, to select further individual patient management tactics.
Materials and methods. The study included 48 patients with single urinary tract stones aged 6 months to 18 years. X-ray structural analysis and determination of the chemical composition was carried out with 39 stone fragments.
Results. In 5 (10.4%) patients with calculi in the distal part of the ureter up to 5 mm in size, medical expulsive therapy was started. 17 (35.4%) patients with kidney and ureter calculi measuring 6-14 mm and density up to 900 HU underwent extracorporeal shock wave lithotripsy. In 3 (6.3%) patients with kidney and ureter calculi 6-14 mm in size and with a density of more than 900 HU, ureterorenoscopy (URS) and extraction using a Dormia basket or forceps to capture fragments were performed. 20 (41.7%) children with kidney stones larger than 15 mm or density greater than 1200 HU underwent contact lithotripsy. Contact endovesical lithotripsy was performed in 2 (4.2%) patients with massive calculi in the urinary bladder who underwent cystoplasty for an exstrophy-epispadias malformation. Results of X-ray structural stones analysis: calcium oxalate (wevelite, wedelite) - 31 (79.5%), calcium phosphate (hydroxyapatite) - 5 (12.8%), brushite - 2 (5.1%), cystine - 1 (2.6%).
Conclusions. Modern minimally invasive technologies make it possible to remove calculi of any density and localization from the urinary system in a minimally traumatic, effective and sufficiently safe manner, regardless of the age of the child. In the treatment of urolithiasis in children, it is advisable to follow a personalized approach with the step-by-step use of the optimal arsenal of means to remove the stone.
The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the local ethics committee of the listed institution. Informed consent of children and their parents was obtained for the research.
No conflict of interest was declared by the authors.
References
Alexander RT et al. (2012, Aug 29). Alberta Kidney Disease Network. Kidney stones and kidney function loss: a cohort study. BMJ. 345: e5287. https://doi.org/10.1136/bmj.e5287; PMid:22936784 PMCid:PMC3431443
Baydilli N et al. (2020). Effectiveness and complications of mini-percutaneous nephrolithotomy in children: one center experience with 232 kidney units. Turk J Urol. 46(1): 69-75. https://doi.org/10.5152/tud.2019.19158; PMid:31747365 PMCid:PMC6944430
Burgos Lucena L, Fernández Bautista B, Parente Hernández A, Ortiz Rodríguez R, Angulo Madero JM. (2021, May 13). Extracorporeal Shock Wave Lithotripsy and Combined Therapy in Children: Efficacy and Long-Term Results. Front Pediatr. 9:609664. https://doi.org/10.3389/fped.2021.609664; PMid:34055678 PMCid:PMC8155519
EAU Guidelines. (2023). Edn. presented at the EAU Annual Congress Milan 2023. ISBN 978-94-92671-19-6.
He Q et al. (2019). Which is the best treatment of pediatric upper urinary tract stones among extracorporeal shockwave lithotripsy, percutaneous nephrolithotomy and retrograde intrarenal surgery: a systematic review. BMC Urol. 19: 98. https://doi.org/10.1186/s12894-019-0520-2; PMid:31640693 PMCid:PMC6806579
Izol V et al. (2020). Which factors affect the success of pediatric PCNL? Single center experience over 20 years. Archivio Italiano Di Urologia E Andrologia. 92(4). https://doi.org/10.4081/aiua.2020.4.345; PMid:33348964
Jurkiewicz B, Samotyjek JK. (2017). Urolithiasis in children - a health problem of civilization. Health Prob Civil. 11(4): 239-246. https://doi.org/10.5114/hpc.2017.71888
Kagalkar S et al. (2020, Jan). Percutaneous nephrolithotomy in the pediatric age group: a study from North Karnataka Int Surg J. 7(1): 117-121. https://doi.org/10.18203/2349-2902.isj20195955
Khan SM et al. (2021, Jun). Analysis of extracorporeal shock-wave lithotripsy in renal calcular disease among children: a tertiary care experience Int Surg J. 8(6): 1820-1825. https://doi.org/10.18203/2349-2902.isj20212278
Kittanamongkolchai W et al. (2017, Mar 7). Risk of Hypertension among First-Time Symptomatic Kidney Stone Formers. Clin J Am Soc Nephrol. 12(3): 476-482. https://doi.org/10.2215/CJN.06600616; PMid:28148559 PMCid:PMC5338710
Sharma AA, Sharma A. (2020, Sep). Nephrolithiasis: Approach to Diagnosis and Management. Indian J Pediatr. 87(9): 716-725. Epub 2020 Aug 14. https://doi.org/10.1007/s12098-020-03424-7; PMid:32794099
Stamatelou KK et al. (2003). Time trends in reported prevalence of kidney stones in the United States:1976-1994. Kidney Int. 63: 1817. https://doi.org/10.1046/j.1523-1755.2003.00917.x; PMid:12675858
Tasian GE et al. (2017). Kidney stone recurrence among children and adolescents. The Journal of urology. 197(1): 246-252. https://doi.org/10.1016/j.juro.2016.07.090; PMid:27521691 PMCid:PMC5161588
Trinchieri A et al. (2003). Epidemiology. In: Stone Disease, C.P. Segura JW, Pak CY, Preminger GM, Tolley D., Editors. Health Publications: Paris.
Vinit N et al. (2021). Extracorporeal Shockwave Lithotripsy for Cystine Stones in Children: An Observational, Retrospective, Single-Center Analysis Frontiers in Pediatrics. 9. https://doi.org/10.3389/fped.2021.763317; PMid:34869121 PMCid:PMC8636798
Wang HH et al. (2015, May). Estimating the nationwide, hospital based economic impact of pediatric urolithiasis. J Urol. 193; Suppl 5: 1855-1859. https://doi.org/10.1016/j.juro.2014.09.116; PMid:25305358 PMCid:PMC4393793
Zhao F et al. (2016, Jan 7). Investigators of Rare Kidney Stone Consortium. Predictors of Incident ESRD among Patients with Primary Hyperoxaluria Presenting Prior to Kidney Failure. Clin J Am Soc Nephrol. 11(1): 119-126. https://doi.org/10.2215/CJN.02810315; PMid:26656319 PMCid:PMC4702224
Zhe M et al. (2017). Nephrolithiasis as a risk factor of chronic kidney disease: a meta-analysis of cohort studies with 4,770,691 participants. Urolithiasis. 45: 441. https://doi.org/10.1007/s00240-016-0938-x; PMid:27837248
Zisman A et al. (2022, Dec 8). Shock Wave Lithotripsy in Pediatric Stone Disease: A 15-Year Single-Center Experience with 2 Types of Lithotripters. Urol Int. 106(12): 1260-1264. https://doi.org/10.1159/000522079; PMid:35172318 PMCid:PMC9811415
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