Microlithiasis In Children Research Articles

Management of testicular microlithiasis in children: A single center experience

Management of testicular microlithiasis in children: A single center experience

Efficacy of Potassium Citrate Solution in the Treatment of Renal Microlithiasis in Children 1 Month to 15 Years-old

Abstract Background and objective: The present research aims to determine efficacy of potassium citrate solution in the treatment of renal microlithiasis in children one month to 15 years old in Shahrekord Pediatric Nephrology Clinic. Methodology: In this clinical trial study, 60 children aged 1 month to 15 years referred to Shahrekord Pediatric Nephrology Clinic who had one or two (microlithiasis) less than 3 mm in ultrasound; They were included in the study by available sampling. Children were randomly divided into 2 groups receiving placebo (water) and receiving potassium citrate solution. After 3 months, the number and size of stones and the consequences of stones were recorded in both groups and analyzed using SPSS software and relevant statistical tests. Results: Out of 60 children studied, 34 were male (56.7%) and 26 were females (43.3%) with a mean age of 61.62 47 47.54 months. After 3 months of intervention, the mean number and size of stones in each group had a significant decrease (P <0.001) and this amount was lower in the group receiving potassium citrate than the group receiving placebo, but this difference was not statistically significant (<0.05). P). Also, the consequences of kidney stones in both groups were similar and there was no significant difference (P <0.05). Conclusion: The results of this study showed that potassium citrate solution has no effect on the treatment of one or two microlithiasis in children and in these patients the use of supportive therapy is still sufficient. Keywords: Kidney stones, Microlithiasis, Children, Potassium citrate

Ectopic Testis and Its Relationship to Testicular Microlithiasis

Testicular microlithiasis (TM) has been defined as 5 or more echogenic petechial foci in a single view of a testicular ultrasound. Most cases are asymptomatic and are only found incidentally when testicular ultrasound is indicated for other conditions. The aim of our study is to evaluate the prevalence of testicular microlithiasis in children with ectopic testis and their association with testicular tumor. Methods:It is a retrospective study involving 8 patients who were diagnosed with TM in the pediatric surgery department of Monastir over a period of 16 years from 2003 to 2019. Results:The average age of children was 6.8 years old. The most common indication for US was cryptorchidism (5 patients); The most common other indications were scrotal pain (1 patient) and testicular mass (1 patient). Two boys had bilateral microlithiasis. We opted for orchidopexy in 6 children with undescended testes. Orchiectomy was indicated for testicular tumour in one case and for testicular regression syndrome in the other case. Two patients had pathologic confirmation of testicular microlithiasis. Patients follow-up was done by tumor marker assay and scrotal Doppler ultrasound. None of these patients developed testicular tumors with mean follow-up of two 2 years. Conclusion: Recent studies found that testicular ultrasonography for cryptorchidism will reveal a 10% incidence of TM in the ectopic testis. The incidence of malignant transformation in a cryptorchid testis associated with microlithiasis is approximately twofold to threefold greater than that of the normal cryptorchid testis. So, we currently recommend the perform intermittent radiologic surveillance for these population.

Prevalence and risk factors of testicular microlithiasis in patients with hypospadias: a retrospective study

BackgroundIt has been described that the incidence of testicular microlithiasis is high in several congenital disorders which may be associated with testicular impairment and infertility. Several reports have shown that a prepubertal or pubertal hormonal abnormality in the pituitary-gonadal axis was identified in some patients with hypospadias that is one of the most common disorders of sex development. However, exact prevalence or risk factors of testicular microlithiasis in patients with hypospadias have not reported so far. In the present study, to clarify the prevalence and risk factors of testicular microlithiasis in patients with hypospadias, a retrospective chart review was performed.MethodsChildren with hypospadias who underwent testicular ultrasonography between January 2010 and April 2016 were enrolled in the present study. Severity of hypospadias was divided into mild and severe. The prevalence and risk factors of testicular microlithiasis or classic testicular microlithiasis were examined.ResultsOf 121 children, mild and severe hypospadias were identified in 66 and 55, respectively. Sixteen children had undescended testis. Median age at ultrasonography evaluation was 1.7 years old. Testicular microlithiasis and classic testicular microlithiasis were documented in 17 children (14.0%) and 8 (6.6%), respectively. Logistic regression analysis revealed that presence of undescended testis was only a significant factor for testicular microlithiasis and classic testicular microlithiasis. The prevalence of testicular microlithiasis or classic testicular microlithiasis was significantly higher in children with undescended testis compared to those without undescended testis (testicular microlithiasis; 43.8% versus 9.5% (p = 0.002), classic testicular microlithiasis; 37.5% versus 1.9% (p < 0.001).ConclusionsThe current study demonstrated that the presence of undescended testis was only a significant risk factor for testicular microlithiasis or classic testicular microlithiasis in patients with hypospadias. As co-existing undescended testis has been reported as a risk factor for testicular dysfunction among patients with hypospadias, the current findings suggest that testicular microlithiasis in children with hypospadias may be associated with impaired testicular function. Conversely, patients with isolated HS seem to have lower risks for testicular impairment. Further investigation with longer follow-up will be needed to clarify these findings.

Clinical characteristics of testicular microlithiasis in children

Objective To improve the understanding of the implications of testicular microlithiasis(TM) in paediatric patients by summarizing the clinical characteristics of TM. Methods One hundred and eighteen boys diagnosed as TM based on ultrasound between March 2006 and December 2014 at Shengjing Hospital Affiliated to China Medical University were retrospectively reviewed.Demographic data, imaging data, indications for ultrasound, associated inguinoscrotal pathologies and follow-up data were collected. Results There were 118 cases of patients aged from 0.25 to 14.00 years(averaging 7.98 years). The indication for ultrasound included health check(22 cases), testicular discomfort(28 cases), small testes(6 cases), scrotal mass(10 cases), with history of cryptorchidism(36 cases), with history of hydrocele(15 cases). Concomitant diseases included congenital anomaly of testis in 44 cases[cryptorchidism(34 cases), testicular absence(4 cases), testicular hypoplasia(6 cases)], hydrocele of tunica vaginalis or hernia(15 cases), testicular epididymitis(12 cases), varicocele(6 cases), epididymal cyst(5 cases), testicular teratomas(2 cases), adrenal cortical hyperplasia(1 case), testicular torsion(1 case), and none associated disease(32 cases). Bilateral TM was in 87 cases(the typical TM in 38 cases, limited TM in 49 cases), while unilateral TM was in 31 cases(the typical TM in 8 cases, limited TM in 23 cases). Fifty-three cases were followed up for 1 month to 36 months(averaging 12.5 months), and the condition was stable, no testicular malignancy was observed during follow-up. Conclusions The TM in children is not a rare disease.The etiology of TM is not clear and there are no special clinical symptoms.TM is often associated with testicular abnormality in pediatric patients and the correlation between children′s TM and adult testicular tumor can not be determined yet.The distribution and involving degree of TM is stable in the short term with infrequent testiculoma, but an appropriate follow-up scheme is required, especially during and after puberty. Key words: Child; Testis; Microlithiasis; Sonography

What do we know about pediatric renal microlithiasis?

Renal or calyceal microlithiasis is a common disorder with increasing prevalence especially in infants and younger children. The main presenting symptoms and the underlying metabolic abnormalities of renal microlithiasis are similar to renal stone. Although renal microlithiasis is considered as a main problem of the health system with diverse etiologies, our information about its natural course is very limited. Hence, further investigations to make an appropriate clinical approach to this entity is mandatory. Also, general practitioners, pediatricians, nephrologists and urologists have to be well educated regarding renal microlithiasis for early diagnosis, appropriate evaluation and proper management of this entity. In this review study, we focused on collection of the present information about different aspects of renal microlithiasis in children

Long-Term Follow-Up of Testicular Microlithiasis in Children and Adolescents: Multicenter Prospective Cohort Study of the Italian Society of Pediatric Urology

Introduction Testicular microlithiasis (TM), characterized by the presence of intratubular calcifications in a single or both the gonads, is an uncommon entity with unknown etiology and outcome in pediatric and adolescent age. In this study, the results of a multicenter long-term survey are presented. Materials and Methods From 11 units of pediatric urology/surgery, patients with TM were identified and yearly, followed up in a 7-year period, adopting a specific database. The recorded items were: age at diagnosis, presenting symptoms/associated abnormalities, ultrasonographic finding, surgery and histology at biopsy, if performed. Results Out of 85 patients, 81 were evaluated yearly (4 patients lost to follow-up). TM was bilateral in 66.6% of the patients. Associate genital abnormalities were present in 90%, more frequently undescended/retractile testis (23.4%) and varicocele (22.2%). TM remained unchanged at 4.7 years follow-up in 77 patients (93.8%) and was reduced in 4 patients after 1 to 5 years of inguinoscrotal surgery. Orchiectomy was performed in three patients (3.7%), one for severe testicular hypoplasia and two for seminoma (2.5%), respectively, concurrent and metachronous to diagnosis of TM. Tumorectomy with parenchymal sparing surgery was performed in a teratoma associated with TM. Conclusion TM is a controversial entity, often associated with several inguinogenital features, which rarely can recover. Testicular malignancy, although present in TM, has not proven definitively associated to microliths. Proper counseling, yearly ultrasound, and self-examination are long-term recommended.

Testicular Microlithiasis in Children and Associated Testicular Cancer

Testicular Microlithiasis in Children and Associated Testicular Cancer

Testicular Microlithiasis in Children: Prevalence and Clinical Features

Testicular Microlithiasis in Children: Prevalence and Clinical Features

Clinical importance of renal calyceal microlithiasis in children

Renal calyceal microlithiasis refers to a hyperechogenic spot in renal calyces <3 mm in diameter detected on renal sonography. These spots possibly represent the first step in calculus formation. The aim of this study was to analyze the clinical presentation, predisposing factors, prognosis and clinical importance of these hyperechogenic spots in renal calyces, renal calyceal microlithiasis, during childhood. The data of 292 children (135 girls, 157 boys) with microlithiasis diagnosed between January 1998 and December 2010 were evaluated retrospectively. Demographic data, serum biochemistry, urinary metabolic factors, and renal sonography results were obtained from patient files. A total of 228 patients were re-evaluated at least 6 months after the first observation of renal calyceal microlithiasis and at 6-12 month intervals thereafter. Mean age was 16.8 ± 14.9 months, and mean follow-up duration was 14.6 ± 5.9 months. Presenting symptoms were abdominal or flank pain (41.1%), hematuria (35.6%), dysuria (24.7%) and urinary tract infection (34.6%). Previous ultrasounds were normal in 35% of the children. Metabolic and anatomic abnormalities were found in 55.5% and 17.8%, respectively. Hypercalciuria was the most common metabolic abnormality (88.9%). Among 228 patients who had been re-evaluated, microlithiasis disappeared in 37.7%; decreased in number or size in 23.7%; progressed to renal stone formation in 10.6%; increased in number of microlithiasis in 19.0%; and remained unchanged on radiology in 9.0%. Renal calyceal microlithiasis represents a spectrum of clinical situations and underlying metabolic abnormalities that need further investigation in children.

Testicular Microlithiasis in Children and Associated Testicular Cancer

To evaluate the prevalence of testicular microlithiasis (TM) in children who have undergone scrotal ultrasonography (US) and their association with testicular tumors. This HIPAA-compliant study with waiver of informed consent was approved by the institutional review board. From 2003 to 2012, all patients with scrotal US and report mentioning calcifications or microlithiasis and all patients with testicular tumors from pathology database were identified. US studies were evaluated for the type of TM (classic ≥5 microliths or limited <5 microliths in a single view) and change in follow-up studies if available. Medical charts were reviewed for US indication, underlying medical conditions, and pathologic abnormalities, when available. Fisher exact test was used to analyze the association of testicular tumors and TM. A total of 3370 boys had scrotal US, 83 (2%) of whom had TM or microcalcifications in the report. TM was usually bilateral (n = 62, 75%) and classic (n = 59, 71%) type.TM was significantly less common in those younger than 2 years of age than in older age groups (0.1% vs 3.1%, P < .0001). The most common indication for US was scrotal pain (40 of 83 patients, 48%), and the most common associated medical condition was cryptorchidism (nine of 83 patients, 11%). Testicular tumor was significantly more likely in boys with TM (12% vs 0.3%, P < .01). Five (83%) of six patients with premalignant or benign tumors had a premalignant condition (cryptochydism in two and Peutz-Jeghers syndrome in three). Four patients with TM had malignant testicular tumors, all diagnosed after the age of 16 years. TM has a prevalence of 2% in boys who undergo scrotal US. It is most commonly bilateral, classic type, and stable at follow-up studies. There is a significant association of TM and testicular tumors. Malignant tumors were seen only in adolescent boys.

Pulmonary Alveolar Microlithiasis in Children: Case Series and Review of Literature.

Pulmonary alveolar microlithiasis is rare in children. It presents as a chronic disease with early asymptomatic course and is usually idiopathic. Characteristic radiology and high index of suspicion can lead to early diagnosis by lung biopsy. Treatment with drugs targeting phosphate metabolism may be beneficial. We present a series of 3 pediatric cases confirmed by lung biopsies, along with review of literature.

Melamine Related Bilateral Renal Calculi in 50 Children: Single Center Experience in Clinical Diagnosis and Treatment

We investigated the clinical diagnosis and treatment features of bilateral renal calculi in young children who ingested melamine tainted infant milk formula. We retrospectively analyzed clinical data on 50 children (mean +/- SE age 23.4 +/- 3.1 months) with a history of ingesting melamine tainted infant milk formula and suffering from bilateral renal calculi. All patients underwent ultrasound and renal function evaluation. Treatment included cessation of melamine tainted formula consumption, hydration, urine basification and hemodialysis if necessary. Bilateral renal calculi peaked in 6 to 18-month-olds (58% of cases). The male-to-female ratio was 3.1:1.0. Calculi ranged in diameter from 4 to 10 mm in 33 patients (66%) and 2.5 to 4 mm in 17 (34%). Of the 11 patients with renal failure 8 underwent 1 to 4 sessions of hemodialysis. Of the 9 bilateral obstruction cases with renal failure 8 did not require surgical intervention but 1 required ureteral catheterization to drain the renal pelvis. All children experienced a good outcome and were discharged home after a mean +/- SE hospitalization of 8.1 +/- 0.7 days. Melamine related urinary calculi were most often seen in patients 6 to 18 months old. Conservative management has been sufficient in most cases. However, these children need to be monitored for long-term effects of melamine tainted milk formula consumption.

Clinical and metabolic features of urolithiasis and microlithiasis in children

We evaluated the clinical, radiological and metabolic features of 162 children with urolithiasis or microlithiasis who had been referred to our pediatric nephrology clinics between 1998 and 2008 with suspected urolithiasis. The medical histories of these children (78 girls, 84 boys), who ranged in age from 2 months to 16 years (mean age 5.59 +/- 0.35 years), were reviewed retrospectively for clinical and metabolic features of urinary tract calculi. Urinary tract infections (UTI) were present in 45.9% of the cases. The most common presenting symptoms were flank pain or restlessness (25.3%) and hematuria (21.6%), followed by UTI (16%), whereas 23.5% of the cases were detected incidentally during evaluation for other medical conditions. Other symptoms at presentation included dysuria, passing stones, penile edema, enuresis, vomiting and anorexia. Urine analysis revealed metabolic abnormalities in 87% of the cases, including hypercalciuria (33.8%), hypocitraturia (33.1%), hyperoxaluria (26.5%), hyperuricosuria (25.4%), hypocitraturia + hypercalciuria (21.1%), hyperphosphaturia (20.8%) and cystinuria (5.7%). Almost 50% of the patients had a positive family history for urolithiasis. The most frequently involved site was in the kidneys (86%). Ureters and bladder were involved in 12 and 2% of the cases, respectively. A family history of urolithiasis, presenting symptoms and underlying metabolic abnormalities were similar for microlithiasis and the patients with larger stones. However, in our study population, microlithiasis was mainly a disease of young infants, with a greater chance for remission and often not associated with structural changes. The presenting symptoms of urolithiasis show a wide spectrum, so that a high index of suspicion is important for early detection. A metabolic abnormality can be identified in 87% of cases of urolithiasis. Detection of microlithiasis may explain a number of symptoms, thus reducing invasive diagnostic procedures and allowing early recognition of metabolic abnormalities. These results draw attention to the importance of screening for UTIs in patients with urolithiasis.

Testicular microlithiasis in children: sonographic features and clinical implications.

The natural history of incidentally discovered testicular microlithiasis in children has not been well defined. Although a benign condition, this entity has been found to be associated with testicular malignancies. To determine the spectrum of sonographic findings and clinical implications in children with testicular microlithiasis. During a 3.5-year period, 850 scrotal examinations with grey-scale US detected testicular microlithiasis in 16 boys (1.9%), age range 6-18 years. The US records of these patients were retrospectively analysed for distribution and pattern of this finding. The presence of intratesticular pathology was determined and the medical records and pathological reports were reviewed. In five patients, US re-evaluation up to 6 years could be performed. Typical punctate hyperechoic foci were found bilaterally in all cases except five, which showed only unilateral foci. Additional pathology was depicted in four patients (chorioncarcinoma n=1; a cystic lesion in a patient with a large-cell calcifying Sertoli-cell tumour, n=1; diffuse structural alterations after orchidopexy, n=2). No testicular tumour developed during clinical follow-up. The association with benign and malignant testicular tumours, as described in adults, also seems valid in the paediatric age group. Therefore, children with testicular microlithiasis should have clinical and US long-term follow-up.

Multi-institutional study of testicular microlithiasis in childhood: a benign or premalignant condition?

Testicular microlithiasis, a rare ultrasonographic diagnosis in children, has been shown to coexist in benign and malignant conditions. The natural history of incidentally discovered testicular microlithiasis has not been well defined in the pediatric population. The concern that testicular microlithiasis may be a premalignant condition has been raised. Reports indicate as much as a 45% association of germ cell tumors with testicular microlithiasis at the time of tumor diagnosis and there have been 4 cases of interval testicular tumor development associated with preexisting testicular microlithiasis. To address this issue we performed a multi-institutional study to evaluate children with incidentally diagnosed testicular microlithiasis. Data on 26 patients with a mean age of 12.3 years at presentation with incidentally discovered testicular microlithiasis were collected from 7 institutions. Presenting scrotal conditions were reviewed. Two children with a previous testicular malignancy were excluded from study. Followup ranged from 1 month to 7 years (mean 27.6 months). Testicular biopsy and tumor marker (alpha-fetoprotein and beta-human chorionic gonadotropin) determinations were performed in 9 and 15 patients, respectively. To date no testicular tumor has developed during clinical followup. Our multi-institutional study has not yet shown a trend toward the malignant degeneration of incidentally diagnosed testicular microlithiasis in children. However, we still advocate close surveillance of patients with testicular microlithiasis, such as yearly testicular ultrasound, physical examination, and judicious tumor marker determinations. We propose that a registry be started to follow prospectively patients with testicular microlithiasis to define its significance better.

MULTI-INSTITUTIONAL STUDY OF TESTICULAR MICROLITHIASIS IN CHILDHOOD: A BENIGN OR PREMALIGNANT CONDITION?

Purpose Testicular microlithiasis, a rare ultrasonographic diagnosis in children, has been shown to coexist in benign and malignant conditions. The natural history of incidentally discovered testicular microlithiasis has not been well defined in the pediatric population. The concern that testicular microlithiasis may be a premalignant condition has been raised. Reports indicate as much as a 45% association of germ cell tumors with testicular microlithiasis at the time of tumor diagnosis and there have been 4 cases of interval testicular tumor development associated with preexisting testicular microlithiasis. To address this issue we performed a multi-institutional study to evaluate children with incidentally diagnosed testicular microlithiasis. Materials and Methods Data on 26 patients with a mean age of 12.3 years at presentation with incidentally discovered testicular microlithiasis were collected from 7 institutions. Presenting scrotal conditions were reviewed. Two children with a previous testicular malignancy were excluded from study. Results Followup ranged from 1 month to 7 years (mean 27.6 months). Testicular biopsy and tumor marker (alpha-fetoprotein and beta-human chorionic gonadotropin) determinations were performed in 9 and 15 patients, respectively. To date no testicular tumor has developed during clinical followup. Conclusions Our multi-institutional study has not yet shown a trend toward the malignant degeneration of incidentally diagnosed testicular microlithiasis in children. However, we still advocate close surveillance of patients with testicular microlithiasis, such as yearly testicular ultrasound, physical examination, and judicious tumor marker determinations. We propose that a registry be started to follow prospectively patients with testicular microlithiasis to define its significance better.

Calyceal microlithiasis in children: report on 196 cases.

Recognition of children at greatest risk for urolithiasis may allow early detection or prevention of stone formation. We report clinical data from 196 children aged 0.9-15.9 years in whom renal ultrasound examination revealed hyperechogenic spots in renal calyces less than 3 mm in diameter. We called this finding "calyceal microlithiasis" (CM). There was a history of urolithiasis in 70.4% of patients in at least one first- or second-degree relative. Presenting symptoms were recurrent abdominal pain, dysuria, and hematuria, occurring alone or in combination. Hematuria was the presenting symptom in 41% of patients and was the only urinary finding in more than one-third. Hypercalciuria was present in about one-third and hyperuricuria in one-fifth of the patients. Of 29 patients who were followed for at least 2 years, 9 developed calculi 4-7 mm in diameter. CM possibly represents the first step in calculus formation. The finding of CM might explain a number of symptoms and signs that are often mild and non-specific, thus reducing invasive diagnostic procedures.

Pulmonary alveolar microlithiasis in children: radiographic and high-resolution CT findings.

Pulmonary alveolar microlithiasis in children: radiographic and high-resolution CT findings.T H Helbich, C Wojnarovsky, P Wunderbaldinger, G Heinz-Peer, I Eichler and C J HeroldAudio Available | Share

Pulmonary alveolar microlithiasis in children.

Two asymptomatic Turkish sibs are presented, a 4-year-old boy and his 7-year-old sister, with pulmonary alveolar microlithiasis (PAM) confirmed by transbronchial lung biopsy and bronchoalveolar lavage. Chest radiographs and high resolution CT demonstrated widespread intra-alveolar calcifications in both lungs. The lesions were sharply defined and less than 1 mm in diameter. CT documented a high concentration of microliths along the bronchovascular bundles, the intralobular fissure and the (sub)pleural lung parenchyma. The combination of bronchoalveolar lavage and roentgenographic appearance in high resolution CT are characteristic and pathognomonic, and can confirm the diagnosis. The more severe changes in the elder sib and the radiographic controls suggest that the pulmonary disease may be progressive in our patients. The described family of consanguineous, unaffected parents with two affected and one healthy child confirmed the autosomal recessive inheritance of PAM (McKusick 265100). In addition, the affected girl had autosomal recessive Waardenburg-anophthalmia syndrome (McKusick 206920), raising the question of whether this is a chance occurrence or possibly a contiguous gene syndrome.