Incidence Of Pediatric Urolithiasis Research Articles

Minimally invasive surgery for pediatric renal and ureteric stones: A therapeutic update.

The incidence of pediatric urolithiasis (PU) is growing worldwide. The corresponding therapeutic methods have become a research hot spot in pediatric urology. PU has the characteristics of abnormal metabolism, easy recurrence, and immature urinary system development, which make its treatment different from that of adults. Pediatric urologists should select the optimal treatment modality to completely remove the stones to prevent recurrence. Currently, the curative treatments of PU include extracorporeal shock wave lithotripsy (ESWL), ureteroscopy, retrograde intrarenal surgery, percutaneous nephrolithotomy (PCNL), laparoscopic, robot-assisted laparoscopic, and open surgery. This review aims to conduct a therapeutic update on the surgical interventions of both pediatric renal and ureteric stones. It accentuates that pediatric surgeons or urologists should bear in mind the pros and cons of various minimally invasive surgical treatments under different conditions. In the future, the treatment of PU will be more refined due to the advancement of technology and the development of surgical instruments. However, a comprehensive understanding of the affected factors should be taken into account by pediatric urologists to select the most beneficial treatment plan for individual children to achieve precise treatment.

Association of Vitamin D Receptor TaqI Gene Polymorphisms and Susceptibility to Pediatric Urolithiasis in the Iranian Population

Background: Due to the lack of research on pediatric urolithiasis (PU) in Iran, this case-control study aimed to assess the correlation of vitamin D receptor (VDR) gene polymorphisms in the Iranian population living in Kerman, Iran. Methods: This study was conducted on 90 outpatients with urinary calculi (49 female and 41 male subjects with a mean age of 4.55 ± 3.005 years) and 90 healthy children (39 female and 51 male subjects with a mean age of 5.6 ± 3.67 years) without a history of urolithiasis as the control group. Deoxyribonucleic acid was extracted from the blood samples of all patients and healthy subjects, and TaqI genotyping was performed via the restriction fragment length polymorphism method. Results: TaqI single-nucleotide polymorphisms (rs731236) were shown to be associated with a higher incidence of PU. Multivariable logistic regression analysis demonstrated that carriers with the C allele of TaqIrs731236 had a considerably higher risk of PU than the control group (odds ratio = 1.94; 95% confidence interval = 1.24 - 2.96; P = 0.004). Conclusions: The obtained findings demonstrated that C allele (rs731236) and CC variant genotypes were considerably linked with a higher risk of PU in children in the Iranian population.

Effect of age, BMI, and gender on urinary risk factors in pediatric idiopathic stone formers

The incidence of pediatric urolithiasis has been increasing over the years; however, the etiology of this increase is not well understood. Age, body mass index, and gender have been examined as possible risk factors for stone disease, but with inconsistent and variable associations. We aim to investigate the urine chemistry factors, as assessed by 24-h urinary parameters, in pediatric stone formers at a large volume tertiary referral center in the highest areas in the United States, the Southeast, based on age, body mass index, and gender. We retrospectively reviewed all pediatric stone formers who completed a 24-h study between 2005 and 2016. Patients were stratified by age (3-10 versus 11-18 years of age), overweight status (above versus below the 85th percentile for body mass index), and gender (male versus female) (Summary Figure). Statistical analysis included analysis of variance and logistic regression. 243 patients were included in our analysis. Patients in the first decade of life were found to have greater numbers of urinary risk factors than those in the second decade. Non-overweight patients were more likely to have hyperoxaluria and hyperuricosuria, while overweight patients were more likely to have hypocitraturia. Female patients were more likely to have higher hyperoxaluria, while male patients were more likely to have hypercalciuria. In contrast to prior publications, obesity is not linked to increased risk of urolithiasis with non-overweight individuals having a greater number of risk factors than the overweight cohort. Despite stone disease being more prevalent in adolescents, the greatest number of risk factors were present in the first decade of life. Lastly, female children had more urinary risk factors than males. Further understanding of the underlying causes of stone disease in various pediatric populations is warranted. While more urinary risk factors were identified in younger, non-overweight, and female patients, there remains no consensus on the urinary risk factors for pediatric urolithiasis. Further study is needed to elucidate the risk factors and pathophysiology of pediatric stone disease.

Laparoscopic Surgery in Pediatric Upper Tract Urolithiasis: An Alternate Modality.

Introduction:Incidence of pediatric urolithiasis has increased over the last few decades. Procedures such as extracorporeal short wave lithotripsy, percutaneous nephrolithotripsy, and ureterorenoscopic lithotripsy are not widely available for pediatric age group in many developing countries. It is desirable that advantages of minimally invasive surgery be offered to selected cases with urolithiasis.Materials and Methods:All patients with pediatric upper tract urolithiasis managed laparoscopically from January 2015 to April 2020 were retrospectively reviewed.Results:A total of 38 patients were included. The mean age of the patients was 8 ± 2.85 years. Thirty-four patients (renal and upper ureteric) were managed through retroperitoneal approach, while those with lower ureteric calculi (n = 4) were approached transperitoneally. A total of eight patients required conversion to open technique. The stone clearance rate was 79% by laparoscopic approach alone. There were no procedure-related complications.Conclusion:Our study suggests that laparoscopic management for pediatric upper tract urolithiasis is a radiation-free, single-time curative treatment and is feasible in centers where facilities for other endoscopic procedures are unavailable.

Minimally Invasive Approaches in Pediatric Urolithiasis. The Experience of Two Italian Centers of Pediatric Surgery.

Background: Over the last 30 years, the incidence of pediatric urolithiasis (PU) has been increasing and the surgical management has evolved toward a minimally invasive approach (MIA). We reported the experience of two Centers of Pediatric Surgery in the management of PU, focusing on MIA as first choice in treatment.Methods: Data were retrospectively analyzed from October 2009 to October 2019 in children with urolithiasis who were admitted to two referral Italian Centers of Pediatric Surgery. Demographic and clinical data of the patients, features of the urolithiasis, type of surgery were considered.Results: Seventy patients (7.3 ± 5.0 years) with normal renal function were treated for calculi in the pyelocaliceal system (45.7%), ureter (34.3%), bladder (4.3%), urethra (1.4%), and multiple locations (14.3%). Size of calculi was >10 mm in 55.7% of cases (kidney>bladder/urethra>multiple>ureter, p = 0.01). Symptoms were present in 75.7% of patients. Family history was positive in 16.9% of cases. MIA was performed in 59 patients (84.3%): 11.8% shockwave lithotripsy (kidney>ureter>multiple); 32.2% ureteral retrograde surgery (ureteral>other localizations); 30.5% retrograde intrarenal surgery (kidney>other localizations); and 25.4% other procedures including percutaneous nephrolithotomy, cystoscopic bladder stone removal or laser cystolithotripsy (kidney>bladder>multiple). Preoperative stenting was necessary in 52.8% of cases. Four MIA procedures (6.9%, kidney>ureter/multiple) were converted to open surgery. Open surgery was required as first approach in 15.7% of patients (kidney>ureter>multiple) who needed urgent surgery or had associated congenital renal anomalies. In 18/70 of children (25.7%), with prevalence of stones in kidney and multiple location (p < 0.01), a second procedure completed the treatment (88.8% MIA). Intraoperative difficulties were recorded in 8.5% of cases, without difference between location and size of calculi. Late complications (5.7%) were related to displacement and infection of the ureteral stent.Conclusions: MIA resulted to be feasible in more than 75% of primary surgery and in more than 85% of cases requiring a second procedure. Preoperative stent was mandatory in more than 50% of children. The technological evolution allowed to overcome many of the technical difficulties related to the approach to the papilla and lower calyxes. Open surgery is reserved for selected cases and endoscopic surgery represents the best choice of treatment for PU.

PD14-01 INCREASED RISK OF NEW PERSISTENT OPIOID USE IN PEDIATRIC AND YOUNG ADULT UROLITHIASIS PATIENTS PRESCRIBED OPIOIDS AT PRESENTATION

INTRODUCTION AND OBJECTIVE:Pediatric and young adults are a vulnerable patient population for development of addiction after opioid exposure. The incidence of pediatric urolithiasis has been steadi...

Pediatric urolithiasis in Morocco: Composition of 432 urinary calculi analyzed by infrared spectroscopy

Incidence of pediatric urolithiasis is decreasing in most developing countries where endemic bladder stones are less prevalent than in the past years. In parallel, stone composition has changed. Only few data are available in North Africa, except for Tunisia. We report stone composition in the Moroccan pediatric population. Composition of 432 stones from children (302 boys, 130 girls) was determined by infrared spectroscopy. The samples were collected during the period 1999-2016. Stone morphology, which is an important aspect for etiology was determined by examination of each stone under a stereomicroscope. Stone composition was compared to patients' age and gender. The global male-to-female ratio was 2.32. Regarding stone composition, calcium oxalate was the main component in 51.6% of the stones, followed by struvite (18.1%), ammonium urate (9.5%) and carbapatite (9%). Significant differences were found between males and females: calcium oxalate accounted for 72.3% of stones in girls and 42.7% in boys (P<10-6); conversely, struvite was more frequent in boys than in girls (22.2 vs 8.5%, P<10-4). The same was found for calcium phosphate stones (11.9% in boys; 4.6% in girls, P<0.05). Stone morphology helped us for detecting several pathological conditions: type Ic whewellite stones, as a marker for primary hyperoxaluria, was found in 17.6% of stones and type IIId ammonium urate stones, suggestive for infectious diarrhea, was identified in 20.1% of all stones. This is the largest series of pediatric stones in Morocco studied by infrared analysis and morphological examination. 3.

Epidemiological characteristics of childhood urolithiasis in Morocco

ObjectivesDue to the increase observed in the incidence of pediatric urolithiasis in the world, and the scarcity of studies of this pathology in Morocco, we assessed whether epidemiological characteristics of pediatric urolithiasis have a similar profile like in developed countries further we tried to assess the prevalence of this pathology among children in Hassan II University-Hospital of Fez. Subjects and methodsBetween January 2003 to November 2013, 104 pediatric patients with urolithiasis were presented to Hassan II University-Hospital of Fez. Eighty one were boys and 23 girls. Patients were referred from different regions of Moroccan states. ResultsOut of 104 children diagnosed with urolithiasis, 5 patients with positive family history of renal stones, and 12 were recurrent (12%).Their age varied between 8 months and 15 years old, with a mean age of 7.86±4. The sex ratio was 3.5:1 boys to girls. Clinical presentations were dominated by micturition disorder (59%), abdominal or flank pain (28%), nephritic colic (22%), hematuria (22%) and urinary tract infection (13%). Stones were located in the upper urinary tract in 62.5% of cases.Stones were treated by surgery in 89 cases (89%), and with ESWL in only 2 cases (2%).Over these years of study, a prevalence of 0.83% of childhood urolithiasis was calculated. ConclusionsThis preliminary study represents only a region of the country, so more epidemiological analyses should be done.Stone analysis should be performed more frequently, and patients must be presented at earlier stages, before any development of renal failure.

Metabolic features and renal outcomes of urolithiasis in children

Aim: The incidence of pediatric urolithiasis has increased over the last century because of dietary changes, metabolic abnormalities, climate change, and genitourinary abnormalities. Data on pediatric urolithiasis in non-endemic countries are limited. The aim of this study was to evaluate the clinical findings and metabolic etiology of urolithiasis in Korean children. Material and methods: The medical records of 73 Korean children who were newly diagnosed with urolithiasis from January 2010 to December 2013 were retrospectively analyzed. Evaluation of metabolic risk factors, including hypercalciuria, hyperuricosuria, hypomagnesuria, hyperoxaluria, and hypocitraturia, required analysis of 24-h urine specimens or, alternatively, for infants and toddlers, the solute-creatinine ratio in spot urine. Results: The male-to-female ratio of the included patients was 1.3:1. The median age at diagnosis was 10.1 years, and the patients were divided into two age groups with pre-school-age children (n = 27, 37.0%) and school-age children (n = 46, 63.0%). While flank pain was more common in school-age children, incidentally detected or urinary tract infection (UTI)-associated urolithiasis was more common in pre-school-age children. Eight patients (11.0%) had renal function deterioration associated with urolithiasis, and three patients (4.1%) progressed to chronic kidney disease. Metabolic abnormalities according to urine chemistry were found in 30 patients (41.1%), including hypercalciuria in 21.9%, hyperuricosuria in 11.0%, hypomagnesuria in 4.1%, hyperoxaluria in 1.4%, hypocitraturia in 1.4%, and cystinuria in 1.4%. Conclusion: We suggest that school-age children with renal colic and pre-school-age children with UTI should be evaluated for urolithiasis. Additionally, the evaluation for metabolic risk factors is important in order to prevent recurrence and renal insufficiency.

Ureteroscopy for Treatment of Upper Urinary Tract Stones in Children: Technical Considerations

The incidence of pediatric urolithiasis is increasing. While many smaller stones may pass spontaneously, surgical therapy is sometimes warranted. Surgical options include shock wave lithotripsy, ureteroscopy, percutaneous nephrolithotomy, and open surgery. Ureteroscopy represents a minimally invasive approach, and it is increasingly being used to treat pediatric upper tract calculi. Ureteroscopy is performed under anesthesia and fluoroscopic guidance, with basket extraction or lithotripsy of the calculi. Technical considerations include active or passive ureteral dilatation, the use of ureteral access sheaths for larger stone burdens, and post-operative stent placement. The current pediatric literature suggests high success rates (equal to or surpassing shock wave lithotripsy) and low complication rates. However, concerns remain regarding feasibility in patients with variant anatomies and risk due to intra-operative radiation exposure.

Epidemiological Trends in Pediatric Urolithiasis at United States Freestanding Pediatric Hospitals

Anecdotal and lay press reports suggest that the incidence of pediatric urolithiasis is increasing but reliable data are lacking. The objective of this study was to examine trends in the epidemiology of urolithiasis at pediatric hospitals nationwide. The Pediatric Health Information System database is a national database covering 42 freestanding United States pediatric hospitals that captures inpatient admissions, and emergency department and outpatient surgery visits. We searched the Pediatric Health Information System database to identify children (18 years old or younger) treated for urolithiasis between 1999 and 2008. Patients with urolithiasis were measured as a proportion of the total number of patients seen per hospital annually. Trends were verified by comparing results to 2 other common pediatric diagnoses-appendicitis and viral bronchiolitis. We identified 7,921 children diagnosed with urolithiasis during the study period. The total number of children with urolithiasis seen in Pediatric Health Information System hospitals increased from 125 in 1999 to 1,389 in 2008. Mean number of stone cases per hospital per year increased from 13.9 to 32.6. Compared to total hospital patients, the proportion of patients with pediatric urolithiasis increased from 18.4 per 100,000 in 1999 to 57.0 per 100,000 in 2008, an adjusted annual increase of 10.6% (p <0.0001). Urolithiasis also increased compared to appendicitis (p <0.0001) and bronchiolitis (p <0.0001). Even after correcting for increases in total patient volume at Pediatric Health Information System hospitals, there has been a significant increase in the number of children diagnosed with and treated for urolithiasis at these hospitals in the last decade.

Possible causes for the low prevalence of pediatric urolithiasis

Objectives. To determine why the incidence of pediatric urolithiasis is less than that of adult urolithiasis, we investigated the difference in inhibition of calcium oxalate (CaOX) crystallization between pediatric and adult urinary macromolecules (UMMs). Methods. Urinary parameters in relation to urolithiasis, the inhibition of CaOX crystallization of original urine and urine from which UMMs (greater than 3 kDa) had been removed, and the inhibition of CaOX crystal growth and aggregation of UMMs alone were measured. These inhibitory activities were compared between children and adults. Results. In the original urine, the inhibition of CaOX crystallization was significantly stronger for children than for adults, but was the same in urine from which the UMMs had been removed. The inhibition of CaOX crystal growth by UMMs alone showed no significant differences between children and adults; their inhibition of CaOX crystal aggregation was significantly stronger for children than for adults. Much more glycosaminoglycan (GAG) was included in pediatric UMMs than in adult UMMs, although there was no difference in UMM concentration between urine from children and urine from adults. Conclusions. The lower incidence of CaOX lithiasis in children may be attributed, among other factors, to the stronger inhibition of CaOX crystal aggregation by pediatric UMMs, which in turn might be affected by the higher concentration of GAGs in children’s urine.