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ABSTRACT
Year : 2016  |  Volume : 8  |  Issue : 6  |  Page : 119-121  

Urolithiasis in pediatrics


Date of Web Publication26-Apr-2016

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How to cite this article:
. Urolithiasis in pediatrics. Urol Ann 2016;8, Suppl S2:119-21

How to cite this URL:
. Urolithiasis in pediatrics. Urol Ann [serial online] 2016 [cited 2020 Jan 28];8, Suppl S2:119-21. Available from: http://www.urologyannals.com/text.asp?2016/8/6/119/181201

Renal stones in children

Vasant Talwaker, Joytsna Kirtane, Shivaji Mane


Department of Urology, B. J. Hospital for Children, J. J. Hospital Group, Grant Medical College, Mumbai, Maharashtra, India

The paper reviews 75 patients seen over 22 years in one hospital, situated in a 'non-endemic' area of India. Male preponderance was less marked in children below 12 years than in adults. Bilateral stones were noted in 11 children and were associated with growth retardation and uremia. 2/3 of the kidney units were obstructed and 5 were non-functioning. Residual and recurrent stones were a major problem of operative treatment, that was offered to these patients in the last 22 years.

Extracorporeal lithotripsy will be a better alternative.

Presented at the: 5 th Saudi Urological Conference

King Fahd Military Medical Complex

22-23 March 1989

ESWL in paediatrics a long term follow up study

S. Orkubi, K. Al Otaibi, M. Kourah, M. S. Abomelha


Department of Urology, Riyadh Armed Forces Hospital, Riyadh, Saudi Arabia

In the period from 16 February 1985 and 31 March 1990, we have treated 78 paediatric patients in our ESWL unit (HM3 Dornier Lithotriptor). These patients required 123 treatment sessions with an average of 1250 shocks (10-14 KV). The age varied between 3 and 16 years, weight varied between 11-66 kg and the height range was 83-160 cm.

70 patients presented with virgin stones of a size range between 0.4-3 cm (11 were radiolucent stones). In 66 cases, the stones were renal and 12 were ureteric stones. As an adjuvant therapy, PCN was needed in 6 cases before and only in one case after ESWL therapy. Ureteric catheter was used in limited cases as localization guide.

We have followed up these patients for a period of 4 weeks to 3 years. Our follow up criterias were B.P., biochemistry (renal profile), isotopes studies as renal assignments. Chest X-ray and clinical examination to assess lungs and other near organs. Our results showed no change in B.P., no changes in renal function (few cases showed significant improvement), and also no changes found in lungs or other organs. During the follow up period, 60 patients (76%) were stone free, 13 patients presented with significant stone residual and 6 patients failed to attend follow up.

In conclusion, ESWL is a safe and effective treatment of renal and ureteric stones even at a very young age.

Presented at the: 6 th Saudi Urological Conference

National Guard King Khalid Hospital-Jeddah

27-28 November 1991

Percutaneous nephrolithotomy in children

T. W. Callaway, G. Lingardh, S. Basata, M. Sylven


Department of Surgery, Division of Urology, King Fahad National Guard Hospital, Department of Radiology, King Fahad National Guard Hospital, Riyadh, Saudi Arabia

Extracorporeal shock wave lithotripsy (ESWL) and endourological procedures are generally accepted in the management of the adult patient with renal calculi. ESWL is also widely used in children. However, there are few reports concerning the use of percutaneous nephrolithotomy (PCN) as a modality of treatment for paediatric stone patients. Therefore, we reviewed the use of PCN in children treated at this institution. PCN was performed on 18 children with renal calculi. No mortality resulted from this procedure. Hemorrhage was the major complication. At the end of treatment, 67% of patients were stone free and in 82% of patients all targeted stones were removed. PCN can be considered a successful treatment in the management of the pediatric patient with renal calculi.

Presented at the: 7 th Saudi Urological Conference

Riyadh Armed Forces Hospital

11-12 November 1992

ESWL for urinary tract stones in children

M. Al Turki, A. H. Koko, V. C. Onuora, A. H. Mebad, N. Al Jawini


Department of Urology, Riyadh Medical Complex, Riyadh, Saudi Arabia

With the installation of a Siemens Lithostar in our hospital in 1993, we established a stone clinic and this enable us to keep accurate data pertaining to stone management. In this retrospective study, we sought to determine the effectiveness and safety of extracorporeal shock wave lithotripsy (ESWL) as a method of treatment for urolithiasis in children. Between 1993 and 1998, 67 children with stones in the urinary tract were treated by ESWL in our department. There were 38 boys and 29 girls and their ages ranged from 5-16 years (mean 12.95). The majority of the children presented with pain (79%) or haematuria (13.4%). Diagnosis was established by the use of sonography and IVU. Stone disease was associated with horseshoe kidney, posterior urethral valve, PUJ obstruction and meatal stenosis in one child each. In 53 children, the stones were located in the kidney (36 pelvic, 25 calyceal and 3 staghorn). Eleven children had ureteric and 3 had bladder stones. The stone size ranged between 4 and 40 mm (mean 16). ESWL was done as an outpatient procedure in 20 children and the rest as in-patients. DJ stents were placed in 15 children with bulky stones. General anesthesia was used in 19 patients, usually those below the age of ten years. The others received Pethidine for sedation cum analgesia. The mean number of shocks delivered was 3000 and the generator voltage range from 16 to 19 KV. Most of the patients required only one ESWL session (mean 1.65). The overall stone free rate was 91% achieved during a mean period of 10 weeks. Four children developed febrile urinary tract infection and 2 steinstrase. Our results enable us to conclude that WSEL is an effective and safe treatment modality for urinary tract lithiasis in children.

Presented at the: 12 th Saudi Urology Conference

Al Hada and Taif Armed Forces Hospital Program

23-25 February 1999 (7-9 Dhu Al Qa'dah 1419)

Ureteroscopic treatment of impacted ureteral stones in children

L. El Bendary, A. Zayed, A. Ghobeish, H. M. Kamel


Department of Urology, Zagazig and Suez Canal University, Egypt, Department of Urology, Al Amen Hospital, Taif, Saudi Arabia

Objective: The efficacy and safety of ureteroscopic management of impacted ureteral stones are evaluated.

Materials and Methods: Fourteen children 3-9 years of age had impacted pelvic (10 cases) and iliac (4 cases) stones. Stone size range 1-2.5 cm. Good renal function was documented on IVP and US. Ureteroscopes used were Wolf 6/7.5 and 7/8.5 and stone disintegration was done by pneumatic lithotripsy. Plain radiographs followed the children at 1-4 weeks and micturating cystourethrograms at 1 month post-operatively.

Results: All children achieved stone free state by 4 weeks. Stone disintegration was successful in all cases. An indwelling ureteral stent was fixed for 3 weeks in cases with large residual stone burden (5 cases). Post-operative preservation of renal function on IVP (4 cases) and US. Two cases had mild post-op. Reflux which was followed conservatively.

Conclusion: Ureteroscopy with modern small instruments and effective stone disintegration modalities is a safe and effective procedure.

Presented at the: 12 th Saudi Urology Conference

Al Hada and Taif Armed Forces Hospitals Program

23-25 February 1999 (7-9 Dhu Al Qa'dah 1419)

Percutaneous nephrolithotomy in the pediatric population

A. M. Al Shammari, K. Al Otaibi, M. P. Lenoard,

D. Hosking


Department of Urology, Children's Hospital, University of Manitoba, Winnipeg, MB, Canada, Department of Urology, King Fahd National Guard Hospital, Riyadh, Saudi Arabia

Objectives: Percutaneous nephrolithotomy (PCNL) in childhood is an established technique as monotherapy or as part of a multimodal approach for the child with a large stone burden. We received our experience of percutaneous nephrolithotomy in the treatment of nephrolithiasis.

Patients and Method: A retrospective review of children who underwent PCNL procedures for calculi from 1985 to 1996. Antegrade percutaneous access was obtained in all patients and the tract was dilated to 24 French. Grasper forceps, ultrasound and/or electrohydraulic lithotripsy was used to remove and disintegrate the stones. All patients had a nephrostomy tube left in the renal pelvis. All patient had a plain abdominal radiograph and nephrostogram post-operatively. The nephrostomy tube was removed after ensuring free drainage down the ureter and no untoward effects from overnight clamping. Complete anatomical and metabolic work-up was performed in all patients. Patients were followed up at 2-6 weeks, 3 months and 6 months postoperatively with a plain abdominal radiograph and intravenous pyelogram or renal ultrasound.

Results: 10 PCN procedures for renal calculi in 9 renal units were performed on 8 children (5 M, 3 F) aged 41- years (mean 6.4 years). Six patients (75%) presented with pain. Gross hematuria was present in five patients (63%). Three patients had a urinary tract infection. Three patients were found to have associated metabolic abnormalities. No underlying urological anatomical abnormalities were found in these patients. Four renal units were obstructed at the time of presentation and required initial nephrostomy tube insertion. Operative time ranged from 58-240 minutes (mean 131.8 min). A 75% stone free rate for PCNL monotherapy was achieved. This rate increased to 88% with combined PCNL and Extra Corporeal Shock Wave Lithotripsy (ESWL). PCNL was not successful in eradicating a staghorn stone in one patient. Hypothermia occurred in two patients with operative time exceeding 150 minutes. No blood transfusions were required.

Conclusions: Percutaneous nephrolithotomy in children is safe and effective and should be considered in the management of renal calculi in the pediatric population. The addition of ESWL for residual stone may increase the stone free rate. However, staghorn calculi may require alternative forms of management. Children with renal stones should have complete anatomical and metabolic assessment with institution of aggressive medical therapy if appropriate.

Presented at the: 11 th Saudi Urological Conference

King Fahd Military Medical Complex - Dhahran

24-26 February 1998 (27-29 Shawwal 1418)

Minimally invasive surgery and the management of urinary tract stone in children

Jeff-Stephane Valla


Department of Pediatric Surgery, Fondation ELNVAL, Nice, France

Purpose: We present our experience with retroperitoneal, transperitoneal, transvesical lithotomy in pediatric patients in whom shock wave lithotripsy and endoscopic assess failed.

Material and Methods: In a 8 years retrospective study, 12 patients (12 months to 15 years old) underwent minimally invasive surgical treatment of urolithiasis: 1 case of nephrotomy for multiple lithiasis in a caliceal diverticulum (transperitoneal approach), 3 cases of pyelolithotomy (retroperitoneal approach), 3 cases of ureterostomy for low ureteral stone (transperitoneal approach), 5 cases of vesicostomy (intravesical port placement under cystoscopic control. In each case stone were removed with rigid grasper or basket collector under direct laparoscopic vision. The urinary tract was closed in watertight fashion and no catheter was left in place except in two cases where a congenital obstruction (1 case of pyeloureteral obstruction and 1 case of uretero vesical obstruction) was treated in the same time using the same ports.

Results: All cases were completed laparoscopically. Operative time is variable: short (30 min) in case of bladder lithiasis, medium (1.5 hours) in case of pyelo or ureteral lithiasis, long (3 to 4 hours) in case of urinary tract reconstruction (1 pyeloplasty and 1 ureteral reimplantation). A range of 1 to 12 stones were removed. No preoperative complications were noted. Mean hospital stay was 3.4 days. Stone analysis revealed 2 patients with cystinic stones. There was 1 patient (cystinuria) with stone recurrence at a mean follow up of 12 months, and one patient operated by ureterotomy needed post operative ESWL for remaining caliceal stones. The overall long term stone free rate was 92%.

Conclusions: So minimally invasive surgery should be considered as the first choice therapy in some rare selected cases and as salvage or second choice therapy for stone removal after failure of other minimally invasive treatments. This presentation is illustrated by a video.

Presented at the: 18 th Saudi Urological Conference

King Abdulaziz University Hospital

20-23 February 2006 (21-24 Muharram 1427)

Transurethral cystolitholapacy in childen: Long term follow up

Ibraheim H. El-Nono, Tawfiq H. Al Badani, Khalid M. Telha, Mansour H. Al Towity


Department of Urology, Thawra Hospital, Sana'a University, Sana'a, Yemen

Objective: To describe our experience in the treatment of urethral and vesical stones in children using Swiss Lithoclast with long term follow up.

Patients and Methods: In all, 64 transurethral cystolitholapaxy were performed between February 1994 and February 2003 (mean patient age 4 years, range 3-12). All patients were diagnosed with urethral or vesical stones by symptoms, KUB film, ultrasonography, intravenous urography when indicated and urethrocystoscopy. Swiss Lithoclast was used for disintegration of the stones. The mean (range) follow up was 6 (3-11) years. Ascending urethrography was done for 25 patients.

Results: The mean operative duration time was 20 (15-25) minutes. All patients were rendered free of vesical stones. Ascending urethrogram finding were normal in the 25 patients. The hospital stay for all the patients was one day post-operatively.

Conclusions: On the basis of this experience with long-term follow up, we believe that transurethral cystolitholapaxy by Swiss Lithoclast is a potential alternative to cystolithotomy and suprapubic percutaneous cystolitholapaxy in selected pediatric cases.

Presented at the: 18 th Saudi Urological Conference

King Abdulaziz University Hospital

20-23 February 2006 (21-24 Muharram 1427)




 

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