Editorial Comment

Abstract

The stone incidence in children has increased during the past 30 years. 1 VanDervoort K. Wiesen J. Frank R. et al. Urolithiasis in pediatric patients: a single center study of incidence, clinical presentation and outcome. J Urol. 2007; 177: 2300-2305 Abstract Full Text Full Text PDF PubMed Scopus (252) Google Scholar Many believe this is secondary to the increasing obesity in the pediatric population. 2 Srivastava T. Alon U.S. Urolithiasis in adolescent children. Adolesc Med Clin. 2005; 16: 87-109 Crossref PubMed Scopus (36) Google Scholar This parallels observations in adults, with obesity again blamed for the increased stone risk. 3 Straub M. Hautmann R.E. Developments in stone prevention. Curr Opin Urol. 2005; 15: 119-126 Crossref PubMed Scopus (46) Google Scholar As with adults, the major treatment options for pediatric stones include extracorporeal shock wave lithotripsy (ESWL), ureteroscopy with laser and/or basket, percutaneous nephrolithotomy, or open surgery, with open surgery used for combined stone removal and repair of anomalies. A shift has occurred toward less-invasive stone treatment for children in the past 25 years, such having been facilitated by the development of small ureteroscopes and nephroscopes. ESWL is potentially the least invasive modality and is usually performed fairly quickly. This article is a nice report of 24 pediatric cases of nephrolithiasis, each with a relatively large stone burden (average stone size 31 mm for all patients, maximal dimension) successfully treated with ESWL. The clearance rate was high, with 83% of patients ultimately becoming stone free and most requiring >1 ESWL session, with 1 patient requiring 4 sessions. Renal function did not change after ESWL, and there did not seem to be any other short-term sequelae. The complication rate was 25% (colic in 2 and steinstrasse in 4), but only 1 of the 6 patients with complications required hospitalization. No stents were used. This is in contrast to the frequent use of stents after ureteroscopy at other institutions. 4 Tan A.H. Al-Omar M. Denstedt J.D. et al. Ureteroscopy for pediatric urolithiasis: an evolving first-line therapy. Urology. 2005; 65: 153-156 Abstract Full Text Full Text PDF PubMed Scopus (103) Google Scholar Extracorporeal Shock Wave Lithotripsy Monotherapy for Renal Stones >25 mm in ChildrenUrologyVol. 74Issue 1PreviewTo determine the safety and efficacy of extracorporeal shock wave lithotripsy (ESWL) as monotherapy for renal stones >25 mm in children. Full-Text PDF