Stone Disease In Children Research Articles

Endemic Bladder Stone Disease in Children, Pattern And Current Management: Experience From A Centre In Peri-Urban Setting In Pakistan.

To share our recent experience of the pattern and demography of endemic bladder calculi in children and the outcomes of current management strategies for the removal of bladder calculi in a peri-urban setting. This retrospective longitudinal study was carried out at a dedicated urology centre. All patients with endemic bladder stones from January 2020 to December 2021 managed at our centre were included in this study. After discharge, each patient was followed up for 1 year. Data analysis was carried out with IBM SPSS v23. Mean and standard deviation were calculated for normally distributed continuous variables; for non-normally distributed continuous variables, median and IQR were calculated; frequency and percentage were calculated for categorical variables. This study included 254 patients, with a male-to-female ratio of 10.5:1. The mean age of the patients was 4.80 ± 2.86 years. Ninety-one percent of the patients belonged to rural areas. Open cystolithotomy (OC) was performed in 11 (4.3%) patients, transurethral cystolithotripsy (TUCL) in 165 (65.0%), and percutaneous cystolithotomy (PCCL) in 78 (30.7%). The mean operative time was 48.8 ± 4.34 minutes for TUCL, 36.18 ± 7.4 minutes for open cystolithotomy, and 38.6 ± 5.2 minutes for PCCL. The most common stone composition was ammonium urate + calcium phosphate (33.1%). The complication rate was 4.8% in TUCL, 12.8% in PCCL, and 27.3% in open cystolithotomy. Stone clearance was 98.1% for TUCL and 100% for both PCCL and OC. Paediatric bladder calculus is still endemic in rural areas of Sindh with poor socioeconomic backgrounds. Timely diagnosis and early intervention with preventive measures can lead to better outcomes and fewer complications. Minimally invasive methods of cystolithotomy have a shorter hospital stay, are more cost-effective, and have fewer complications as compared to open cystolithotomy.

Validation of stone-kidney size score to predict outcome and complications of pediatric percutaneous nephrolithotomy

The prevelance of urinary system stone disease in children is emphasizing the need for minimally invasive treatments to decrease morbidity and recurrence risk. Percutaneous nephrolithotomy (PCNL) has emerged as a preferred approach for pediatric patients with complex stones due to its minimally invasive nature, including miniaturized and vacuum-assisted access sheaths, advanced laser technology and tubeless and outpatient procedures. However, adult scoring systems have proven ineffective in predicting success and complications in pediatric PCNL. This highlights the need for specialized scoring systems, such as the Stone-Kidney Size (SKS) scoring system, tailored to pediatric patients and will be evaluated in our study for its association with the stone-free rate (SFR) and complications. The data of 144 patients aged <17 years who had undergone PCNL between January 2008 and December 2019 were evaluated retrospectively. Demographics, stone characteristics, perioperative/postoperative outcomes were recorded for each patient. The SKS scoring system comprises the stone kidney index (SKI) and the number of stones, assigns one or two points based on single or multiple stones and an SKI value of <0.3 or ≥0.3, respectively. The SKI is computed by dividing the stone's longest axis by the kidney's longest axis. Residual stones less than 4mm on non-contrast computed tomography are considered clinically insignificant residual fragments (CIRFs). Stone-free and CIRF patients were considered successful results. The relationship between the SKS scoring system and SFR, success, and complication rates after surgery was investigated. Statistical analyses were conducted using SPSS 22.0 software. The SFR was 67.36% and 74.31% when CIRF patients were included, respectively, with a complication rate of 27%. In multivariate analysis, stone treatment history, stone burden, and SKS score were statistically significantly associated with SFR (p<0.001, p=0.032, p<0.001, respectively). Furthermore, the SKS score was the only variable that showed a statistically significant relationship with success. No significant association was found between SKS score and complications (p=0.342). Our study demonstrates a relationship between the SKS scoring system and SFR in pediatric PCNL patients. However, shortcomings have been observed in its capacity to accurately predict post-PCNL complications. Despite being a retrospective analysis and having a single-center design, our study externally validates the relationship between the SKS scoring system and SFR after pediatric PCNL. The SKS scoring system is associated with SFR in pediatric patients undergoing PCNL; however, this relationship has not been established for complications.

Zero-echo time MRI: an alternative method for the diagnosis of urinary stones in children.

To evaluate the potential of zero-echo time-magnetic resonance imaging (ZTE-MRI) in the assessment of urolithiasis and compare ZTE-MRI with computed tomography (CT) in pediatric patients. This was a single-center, prospective cross-sectional study conducted between April 2023 and December 2023. 23 patients (12 girls, 11 boys; mean age: 12.3, range 1-18) with urinary tract stones detected on non-enhanced abdominal CT were enrolled. The images were evaluated independently by two radiologists for the presence, and number of stones in the kidneys, ureters, and bladder. In the second session, two radiologists evaluated whether urinary tract stones could be detected by MRI compared to CT, and the maximum diameter of the stones was measured. The CT and MRI results were compared with the Wilcoxon test. The agreement between the results of the observers was examined using Spearman's rho correlation coefficient and the intraclass correlation coefficient. A total of 58 urinary tract stones were detected by CT and 39 of these were detected by MRI. Most of the stones that MRI could not detect were < 5 mm and the detection sensitivity of MRI increased in correlation with stone size (p < 0.001). There was poor intermodality agreement for stones < 5 mm, substantial agreement for stones 5-10 mm, and almost perfect agreement for stones > 10 mm. Interobserver agreement for stone detection on MRI was almost perfect for stones > 10 mm and 5-10 mm and was substantial for stones < 5 mm. ZTE-MRI is a promising modality for detecting urinary stones without radiation exposure in children. Zero-echo time-magnetic resonance imaging is a potential method for identifying urinary stones in children and other populations who are particularly sensitive to radiation. Urinary system stone disease in children is increasing and imaging is needed for managing urolithiasis. Zero-echo time-magnetic resonance imaging (ZTE-MRI) had an accuracy of 81.8% and 93.7% for stones larger than 5 mm and 10 mm, respectively. ZTE-MRI is a potential non-irradiating method for the diagnosis and management of urolithiasis.

In focus: perplexing increase of urinary stone disease in children, adolescent and young adult women and its economic impact.

Urinary stone disease (USD) historically has affected older men, but studies suggest recent increases in women, leading to a near identical sex incidence ratio. USD incidence has doubled every 10 years, with disproportionate increases amongst children, adolescent, and young adult (AYA) women. USD stone composition in women is frequently apatite (calcium phosphate), which forms in a higher urine pH, low urinary citrate, and an abundance of urinary uric acid, while men produce more calcium oxalate stones. The reasons for this epidemiological trend are unknown. This perspective presents the extent of USD with data from a Canadian Province and a North American institution, explanations for these findings and offers potential solutions to decrease this trend. We describe the economic impact of USD. There was a significant increase of 46% in overall surgical interventions for USD in Ontario. The incidence rose from 47.0/100,000 in 2002 to 68.7/100,000 population in 2016. In a single United States institution, the overall USD annual unique patient count rose from 10,612 to 17,706 from 2015 to 2019, and the proportion of women with USD was much higher than expected. In the 10-17-year-old patients, 50.1% were girls; with 57.5% in the 18-34 age group and 53.6% in the 35-44 age group. The roles of obesity, diet, hormones, environmental factors, infections, and antibiotics, as well as the economic impact, are discussed. We confirm the significant increase in USD among women. We offer potential explanations for this sex disparity, including microbiological and pathophysiological aspects. We also outline innovative solutions - that may require steps beyond typical preventive and treatment recommendations.

Contemporary management of urinary tract stone disease in children within a high volume institution in Mexico

Contemporary management of urinary tract stone disease in children within a high volume institution in Mexico

The intestinal microbiome of children with initial and recurrent nephrolithiasis: A pilot study and exploratory analysis

Kidney stone disease in children is rising disproportionate to the general population, representing a disease population with a distinct biological mechanism as compared to adults. Factors influencing recurrent kidney stone disease in children are poorly characterized and the associations of the intestinal microbiome within sub-populations of kidney stone formers, however, are not well described. We evaluated a pilot cohort of children with nephrolithiasis comparing patients based on recurrent kidney stone episodes and abnormal 24-h urinary parameters, with dual aims to compare the microbiome signal in children with initial and recurrent nephrolithiasis and to explore additional associations in microbiome composition and diversity within this population. Children aged 6-18 with a history of nephrolithiasis, without an active ureteral calculus or antibiotic exposure within 30 days of study entry were eligible to participate. All participants had a 24-h urine study within 6 months of study entry and provided a fecal sample. Microbiome samples were analyzed using 16S ribosomal DNA sequencing techniques for alpha and beta diversity comparing initial and recurrent stone formers as well as microbiome multivariate association (MaAsLin2) to determine differentially abundant taxa. Shotgun sequencing reads were aligned to custom oxidase degradation and butyrate production gene databases (5 databases total). Comparisons for MaAsLin2 and shotgun metagenomics, normalized to sequencing depth, were based on stone recurrence, sex, hypercalcuria (≤4mg/kg/day), hyperoxaluria (≥45 mg/1.73m2), and hypocitraturia (<310 mg/1.73 m2 [females] or<365 mg/1.73 m2 [males]). A total of 16 enrolled children provided samples sufficient for analyses, including 9 girls and 7 boys, of whom 5 had experienced recurrent kidney stone events. Three participants had hypercalcuria, 2 had hyperoxaluria, and 4 had hypocitraturia. Comparisons of Formyl-CoA transferase between index and recurrent urinary stone disease revealed a trend towards higher mean abundance of the gene in initial stone formers (0.166% vs 0.0343%, p=0.2847) (Summary Figure), while trends toward lower biodiversity were also noted in the recurrent stone cohort on both Faith (p=0.06) and Shannon (p=0.05) indices. Exploratory analyses found Eubacterium siraeum to be significantly greater in relative abundance in children with documented hypercalciuria (p=0.001). Our pilot study demonstrates possible signals in both microbial diversity and oxalate gene expression, both of which are lower in recurrent pediatric kidney stone patients. These findings warrant further investigation as a potential diagnostic marker for future kidney stone events.

PD06-02 THE INTESTINAL MICROBIOME VARIES ACROSS PHENOTYPES OF PEDIATRIC NEPHROLITHIASIS

You have accessJournal of UrologyCME1 Apr 2023PD06-02 THE INTESTINAL MICROBIOME VARIES ACROSS PHENOTYPES OF PEDIATRIC NEPHROLITHIASIS Jonathan Ellison, Samantha Atkinson, Michael Hayward, Elise Hokanson, Katherine Sheridan, and Nita Salzman Jonathan EllisonJonathan Ellison More articles by this author , Samantha AtkinsonSamantha Atkinson More articles by this author , Michael HaywardMichael Hayward More articles by this author , Elise HokansonElise Hokanson More articles by this author , Katherine SheridanKatherine Sheridan More articles by this author , and Nita SalzmanNita Salzman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003230.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The intestinal microbiome has been implicated in calcium oxalate kidney stone formation, thought to be driven predominantly through altered breakdown of dietary oxalate. The associations of the intestinal microbiome within sub-populations of kidney stone formers, however, is not well described. We evaluated a pilot cohort of children with nephrolithiasis comparing patients based on recurrent kidney stone episodes and abnormal 24-hour urinary parameters. METHODS: Children aged 6-18 with a history of nephrolithiasis, without an active ureteral calculus or antibiotic exposure within 30 days of study entry were eligible to participate. All participants had a 24-hour urine study within 6 months of study entry and provided a fecal sample. Microbiome samples were analyzed using 16S ribosomal DNA sequencing techniques for alpha and beta diversity comparing initial and recurrent stone formers as well as microbiome multivariate association (MaAsLin2), using a general linear model with fixed effects. Shotgun sequencing reads were aligned to custom oxidase degradation and butyrate production gene databases (5 databases total). Comparisons for MaAsLin2 and shotgun metagenomics, normalized to sequencing depth, were based on stone recurrence, sex, hypercalcuria ( < 4 mg/kg/day), hyperoxaluria ( > 45 mg/1.73 m2), and hypocitraturia (< 310 mg/1.73 m2 [females] or < 365 mg/1.73 m2 [males]). RESULTS: A total of 16 enrolled children provided samples sufficient for analyses, including 9 girls and 7 boys, of whom 5 had experienced recurrent kidney stone events. Three participants had hypercalcuria, 2 had hyperoxaluria, and 4 had hypocitraturia. Alpha and beta-diversity did not differ across initial vs recurrent kidney stones. Exploratory analyses found Eubacteriumsiraeum to be significantly greater in relative abundance in children with documented hypercalciuria (Figure 1). There was no statistical difference in relative gene abundance between groups. CONCLUSIONS: Comparisons across phenotypes of kidney stone disease in children revealed taxonomic differences associated with hypercalcuria. While the mechanisms of these differences are not well defined, these findings support further exploration into non-oxalate related mechanisms of lithogenesis related to the renal-gut axis. Source of Funding: Research Affairs Committee Pilot Grant © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e155 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jonathan Ellison More articles by this author Samantha Atkinson More articles by this author Michael Hayward More articles by this author Elise Hokanson More articles by this author Katherine Sheridan More articles by this author Nita Salzman More articles by this author Expand All Advertisement PDF downloadLoading ...

Paediatric kidney stone surgery: state-of-the-art review.

While urolithiasis in children is rare, the global incidence is rising, and the volume of minimally invasive surgeries being performed reflects this. There have been many developments in the technology, which have supported the advancement of these interventions. However, innovation of this kind has also resulted in wide-ranging practice patterns and debate regarding how they should be best implemented. This is in addition to the extra challenges faced when treating stone disease in children where the patient population often has a higher number of comorbidities and for example, the need to avoid risk such as ionising exposure is higher. The overall result is a number of challenges and controversies surrounding many facets of paediatric stone surgery such as imaging choice, follow-up and different treatment options, for example, medical expulsive therapy, shockwave lithotripsy, ureteroscopy, and percutaneous nephrolithotomy. This article provides an overview of the current status of paediatric stone surgery and discussion on the key topics of debate.

Monogenic causation of pediatric nephrolithiasis

Nephrolithiasis is a condition in which crystals precipitate out of the urine forming kidney stones in the renal calyces and pelvis. Approximately 80% of stones are composed of calcium oxalate and calcium phosphate. In recent years, there has been a significant increase in the prevalence of nephrolithiasis across populations, specifically in that of the pediatric population. The etiology of stone disease is multifactorial, and includes environmental, dietary, hormonal, and genetic factors. Evidence for monogenic causation (also known as Mendelian or single-gene disorders) in nephrolithiasis includes the finding that 30% of children with stone disease report a positive family history, with monogenic nephrolithiasis accounting for approximately 30% of cases. Monogenic nephrolithiasis can occur in isolation or may be the result of an underlying genetic disorder including autosomal dominant hypocalcemia (ADH), primary hyperoxalurias, and hereditary hypophosphatemic rickets with hypercalciuria (HHRH), to name a few. Currently, there are 41 known genes that represent monogenic causes of human nephrolithiasis. Since early detection of these mutations can in some cases prevent the progression to end stage kidney disease in pediatric patients, establishing the genetic basis for nephrolithiasis is increasingly important. Here we provide an overview of kidney stone disease in children with a focus on monogenic causation in the pediatric population.

Is pain perception different in pediatric and adult patients undergoing stone crushing procedure after the application of multimodal analgesia?

Aim: Extracorporeal shock wave lithotripsy (ESWL) is an important modality in the treatment of urinary system stone disease in children and adults. However, ESWL may be painful and stressful procedure. We aimed to examine the differences between pain perception felt during ESWL in children and adult patients after the application of multimodal analgesia. Method: Patients who underwent the stone crushing procedure under multimodal analgesia at the ESWL unit of Mersin University Hospital Urology Clinic between May 2010 and December 2010, were divided into two groups as pediatric and adult. Using the VAS form, the adult patients’ and pediatric patients' pain perception felt during ESWL, were scored and compared. Results: The difference between the mean scores of pain perception felt during ESWL were not significant for all three sessions in both groups. But the difference between the mean scores of pain perception felt during all ESWL sessions between the pediatric and adult groups were significant for all three sessions. The success rate for SWL was calculated as 83.3% for the pediatric group and 80% for the adult group. Conclusion: ESWL is a painful procedure. Our ESWL success rate is compatible with the literature. The pediatric and adult patients successfully completed the ESWL procedure with multimodal analgesia. The pain perception felt during ESWL score was higher in pediatric cases.

Дисметаболічна нефропатія як фактор ризику розвитку пієлонефриту в дітей

Актуальність. Дисметаболічні нефропатії (ДН) сприяють розвитку сечокам'яної хвороби у дітей, виникненню інфекції сечовидільної системи та розвитку вторинного пієлонефриту, тубулоінтерстиціальних змін в нирках. Мета. Аналіз частоти та структури ДН як фактора ризику формування пієлонефриту у дітей. Матеріали та методи. Проведено аналіз 297 випадків у дітей із дисметаболічними нефропатіями. Всім дітям було здійснено загальноклінічне обстеження, ультразвукову діагностику сечовидільної системи, лабораторне обстеження. Результати. Спостерігалося значне переважання чисельності дівчаток (72,6 %) у порівнянні з хлопчиками (27,4 %). У 88,1 % дітей переважали оксалатні нефропатії, що реєструвалися ізольовано. Значно рідше зустрічалися фосфатні й уратні ДН, як ізольовано, так і в поєднанні з оксалатними нефропатіями. Звертало на себе увагу збільшення чисельності дітей із ДН з віком. Питома вага оксалатних, фосфатних і уратних ДН з віком у дітей суттєво не змінювалася та була приблизно однаковою в усіх вікових групах. У 73 % випадків ДН поєднувалися з інфекційно-запальними захворюваннями сечовидільної системи. Так, більше ніж дві третини дітей (68,9 %) мали пієлонефрит. У половини дітей раннього віку відзначалося поєднання ДН з гострим пієлонефритом. Поступово з віком питома вага гострого пієлонефриту зменшувалася та кількість випадків хронічного пієлонефриту (в групі хворих віком 11–17 років він реєструвався у 58,3 % дітей) збільшувалася. Досліджено поширення ДН серед дітей Дніпропетровської області у зв’язку з місцем проживання. Висновки. Серед дитячої популяції відзначається висока частота ДН, серед яких переважають ізольовані оксалатно-кальцієві нефропатії. Ризик розвитку ДН зростає пропорційно віку дитини. Виявлення ДН у дітей перших років життя, особливо у дівчаток, повинне розглядатись як фактор ризику інфекційно-запальних захворювань сечовидільної системи. Найчастіше ДН реєструються у великих промислових центрах області, що є екологічно забрудненими.

Factors Influencing the Success of Shock Wave Lithotripsy Treatment for Urinary System Stone Disease in Children Aged 0-2

Factors Influencing the Success of Shock Wave Lithotripsy Treatment for Urinary System Stone Disease in Children Aged 0-2

Contemporary management of urinary tract stone disease in children within a high volume institution in Mexico.

La urolitiasis en pacientes pediátricos es una condición de baja frecuencia, con tendencia hacia el aumento, por lo que es importante actualizar a urólogos sobre las opciones terapéuticas actuales. Describir las características clínicas, las técnicas quirúrgicas y sus resultados usadas para el tratamiento de la urolitiasis en pacientes pediátricos. El estudio incluyó todos los pacientes menores de 18 años quienes fueron tratados quirúrgicamente por litiasis urinaria desde el año 2017 al 2020, quienes poseían expedientes clínicos completos y seguimiento en el Hospital General de México. Veinte y un pacientes menores de 18 años fueron sometidos a procedimientos quirúrgicos para resolver la litiasis urinaria desde el 2017 al 2020. Los pacientes de sexo masculino fueron más afectados que pacientes del sexo femenino con una relación 3:1. El grupo de edad promedio de presentación fue mayor entre los 1-5 años de edad, la mayoría de pacientes poseían un adecuado índice de masa corporal ajustado por edad. El tracto urinario superior fue el mas afectado, solo 9% se localizó en el tracto urinario inferior, la mayoría de casos se resolvieron con técnicas mínimamente invasivas con una tasa de complicaciones de 14%, llegando al estado libre de litiasis en 90.47% de los casos. La litiasis urinaria es más común en el sexo masculino, generalmente en el grupo de edad pre-escolar. El índice de masa corporal en la mayoría de los casos se encontraba en rangos adecuados para la edad y el abordaje mínimamente invasivo fue utilizado con mayor frecuencia con 14% de complicaciones y un éxito de 90.47%. Pediatric urolithiasis is a rare condition around the world. Its presence and incidence are augmenting in developing countries, remarking the importance for urologists to keep updated to latest trends about its management. The aim of this study was to describe the clinical features and therapeutic surgical options and results for urinary tract stone disease in pediatric patients. This study included all pediatric patients who undergo surgical procedures to manage pediatric urolithiasis between 2017 and 2020 who had complete medical records and adequate follow-up in the General Hospital of México “Dr. Eduardo Liceaga.”. Twenty-one pediatric patients undergo surgical treatment for urinary lithiasis between 2017 and 2020. Males were more affected than female with a relation of 3:1. The mean age at the procedure time was between 1 and 5 years old. The majority of the patients had and adequate body mass index (BMI) according to percentile by age. The upper urinary tract was mostly affected by lithiasis, only 9% of cases were located in the lower urinary tract. The majority of cases were treated with minimal invasive techniques with 14% of complications, and success rate of 90.47%. Urinary lithiasis is more common in male, usually locates at the upper urinary tract, frequently in the group of 1-5 years old, most cases had an adequate BMI, and the most frequently used techniques are minimal invasive, with a lower rate of complications and great success.

Endourology Methods in Pediatric Population for Kidney Stones Located in Lower Calyx: FlexURS vs. Micro PCNL (MicroPERC®).

Kidney stone disease in children is always a therapeutic challenge. It is a multifactorial condition and it should be approached, diagnosed and treated as such. One of the biggest challenges is kidney stones located in the lower renal calyx. There are currently three main surgical techniques to treat this condition: ESWL—Extracorporeal Shock Wave Lithotripsy, RIRS—Retrograde IntraRenal Surgery, and PCNL—PerCutaneous Nephro-Lithotripsy. In pediatric population, the most frequently used method is ESWL, and in the event of failure, endoscopic procedures are the second-best choice. In this article, a sample of 53 children admitted to a tertiary medical center was examined. Thirty-eight of those children underwent flexible URS, while the remaining 15—micro PCNL. The average size of the deposit in the former group was 12.2 mm, against 13.5 mm in the latter. The full Stone Free Rate (SFR) was achieved in RIRS at 84.21 and 86.7% in percutaneous nephrolithotripsy. Flexible ureterorenoscopy and MicroPERC are two comparably effective methods for treating lower calyx stones of any size. However, according to our data, flexible ureterorenoscopy carries a lower risk of complications and inpatient care (with the mean of 3 days). The learning curve for these procedures in pediatric urology is long and relies on a limited number of patients. The number of pediatric patients qualifying for these procedures is restricted also due to the high efficacy of extracorporeal shock wave lithotripsy in pediatric population. Radiation exposure is an important factor in every endoscopy procedure and should never exceed the limits set in the ALARA protocol. ESWL remains to this day the treatment of choice for stone disease in children and can be performed under ultrasound control. For many parents, it is a first-choice treatment preference for their child due to its greater apparent safety, although data on this remains insufficient. Prospective, randomized, multicenter trials are definitely needed.

Treatment Characteristics of Kidney Stone Disease in Children

Kidney stone disease (KSD) is a disease caused by the formation of calculi in kidneys and other parts of the urinary tract. The rate of hospitalization of children with KSD worldwide is increasing. The adequate method of calculus extraction and further therapy according to calculus composition and metabolic disorders are crucial for effective treatment of patients with KSD and recurrence risk reduction. This review covers surgical (extracorporeal lithotripsy, percutaneous nephrolithotripsy, retrograde intrarenal surgery, ureterolithotripsy, laparoscopy, open surgery) and non-surgical (lithokinetic and litholytic) therapy. Special attention is paid to metaphylaxis, or recurrence prevention, and calculi formation. It is noted that medication of children with KSD can be aggravated by various adverse reactions, complexity in drugs dosages in children of first years of life. Moreover, all surgical methods are characterized by high risk of postoperative complications development. The relevance of KSD genetic nature in children, the role of lifestyle changes in disease development, the implementation of new drugs for metabolic disorders correction are presented in the article.

Extracorporeal Shock Wave Lithotripsy and Combined Therapy in Children: Efficacy and Long-Term Results.

Background: Extracorporeal shock wave lithotripsy (ESWL) is nowadays the first choice for the treatment of upper urinary tract stones smaller than 2 cm, considering its low complications and high success rate.Aim: To present an update of the current situation of ESWL treatment and to analyse our series of patients and the efficacy of combined lithiasis treatment in different locations and sizes.Patients and Method: Retrospective study including patients with urolithiasis treated with ESWL between 2007 and 2019. Collected data included: gender and age at treatment, presentation symptoms, imaging studies, stone location and size, complications and stone clearance. Success was defined as stone-free status or the presence of clinically insignificant residual fragments (<4 mm after 3 months follow-up). Patients with residual stones larger than 4 mm after 3 months were programmed for another ESWL session or received a combined sandwich therapy, followed by URS or percutaneous approach.Results: Between 2007 and 2019, 37 patients presented a total of 41 lithiasis episodes that were treated with ESWL sessions. Median age at first procedure was 9 years old (1–17) and median follow-up time was 6 years (3–12). Stones were located in the renal pelvis, followed by the lower, middle and upper calyx, proximal ureter, and 51% of our patients had multiple lithiasis. Median stone size was 12 mm (5–45), the main component being calcium oxalate (34%). During immediate postoperative period, 8 patients (19%) presented complications: renal colic, hematuria and urinary tract infection. After the first ESWL, 41% of the patients (n = 17) were stone-free. Out of the 24 residual lithiasis episodes (58%), three patients (7%) underwent a second ESWL session. In the remaining 19 patients, ESWL was combined with URS or percutaneous approach to achieve complete stone clearance. Overall stone free status after combined therapy was 95% (n = 39).Conclusion: These data support that ESWL is an effective minimally invasive technique, with low cost and morbidity, reproducible and safe for the treatment of stone disease in children. Even though lithiasis size seems to be a significant factor in ESWL success, in combination with other lithotripsy procedures it can reach very high rates of stone clearance.

Acute Kidney Injury Associated With Urinary Stone Disease in Children and Young Adults Presenting to a Pediatric Emergency Department.

Background: Acute kidney injury (AKI) due to urinary stone disease (USD) is rare in adults; AKI rates in children with USD may be higher, and emerging data links stones to chronic kidney disease (CKD) development in adults.Methods: This study is a retrospective analysis of USD patients at a single pediatric hospital system's emergency department (ED). Patients were initially identified by USD ICD codes; USD was then confirmed by imaging or physician documentation; patients had to have baseline creatinine (Cr) and Cr in the ED for comparison to be included. AKI was defined by Kidney Disease: Improving Global Outcomes (KDIGO), Acute Kidney Injury Network (AKIN), and Pediatric Risk, Injury, Failure, Loss, End Stage (pRIFLE).Results: Of the 589 total visits, 264/589 (45%) had data to evaluate for AKI, 23% were AKI(+) and 77% were AKI(–). pRIFLE was most common (82%) and 18% were only positive by AKIN/KDIGO. AKI(+) were more likely to be younger (16.7 vs. 17.4 years, p = 0.046) and more likely to present with vomiting {odds ratio [OR] [95% confidence interval (CI)]: 2.4 [1.4–4.3], p = 0.002}; also, the proportion of AKI(+) was significantly higher in <18 vs. ≥18 years [26.9 vs. 15.5%, p = 0.032, OR (95% CI): 2.0 (1.1–3.9)]. Urinary tract infection (UTI) and obstruction rates were similar between groups. AKI(+) patients had a significant OR <1 suggesting less risk of receiving non-steroidal anti-inflammatory drugs (NSAIDs); however, 51% of them did receive NSAIDs during their ED encounter. AKI(+) patients were more likely to require admission to the hospital (53 vs. 32%, p = 0.001).Conclusion: We have demonstrated a novel association between USD-induced renal colic and AKI in a group of young adults and children. AKI(+) patients were younger and were more likely to present with vomiting. AKI(+) patients did not have higher rates of obstruction or UTI, and 51% of AKI(+) received NSAIDs.

SC337 - Surgical and medical management of stone disease in children under 2 years

SC337 - Surgical and medical management of stone disease in children under 2 years

Medical Expulsive Therapy for Urinary Stone Disease in Children

The rising incidence of urinary stone disease in children requires pediatric practitioners to keep abreast of management recommendations which are generally geared towards adults. Medical expulsive therapy (MET) is a non-surgical therapeutic option that can be trialed in patients who present with uncomplicated symptomatic ureteral stones. Seminal articles published and indexed in Medline on the topic of MET were extracted and reviewed. Studies suggest a potential benefit of alpha-blockade for the expulsion of distal ureteral stones that are >5 mm but ≤10 mm in adults and possibly >4 mm in children. Conversely, there does not seem to be any added benefit for MET in smaller stones (<5 mm) in which the spontaneous passage rate is high. Conclusions: The off-label use of these medications is one of the several barriers which contribute to the underutilization of MET in children. However, these may be a reasonable option in particular for older children and adolescents with the appropriate-sized stones.

EVALUATION OF SAFETY AND EFFICACY OF PERCUTANEOUS NEPHROLITHOTOMY FOR THE TREATMENT OF RENAL STONES IN CHILDREN: EXPERIENCE OF A TERTIARY CARE MEDICAL CENTER

Background: Renal stone disease in children is uncommon and causes a clinical management dilemma due to the size of the urinary tract in children and risk of recurrence. The majority of renal stones are due to metabolic disorders or urinary tract infections with a consequently high lifetime risk of recurrence. Objective: To evaluate safety and efficacy of percutaneous nephrolithotomy for the treatment of pediatric renal stones. Patients and Methods: A prospective clinical trial was carried out during the period from February 2018 to October 2019 of thirty pediatric patients ≤ 18 years old with renal stones ˃ 2 cm, shock wave–resistant stones ˂ 2 cm, and failed chemolysis for radiolucent stones. Patients underwent percutaneous nephrolithotomy (PNL) with tract dilation up to 16 fr. A 8/9.8 Fr semirigid ureteroscope (Richard Wolf, Germany), and Ho: YAG Laser lithotripsy were used. Patients were followed up after 3 months of the operation by plain X-ray (Kidney, ureters, bladder [KUB]) (or pelvi abdominal ultrasound [US] for radiolucent stones) & renal isotope to assess safety and efficacy of percutaneous nephrolithotomy. The data were analyzed using the appropriate statistical tests. Results: Our study showed that PNL achieved high stone clearance rate (86.7 %) for management of renal stones in children, with accepted postoperative morbidity. The mean age was 8.48 years (range 2 – 18). Mean diameter of the stone was 21.68 ± 5.55 with a range 10 – 30 mm. Mean operative time was 106.93 ± 13.89 with a range 85 – 135 minutes. Mean hemoglobin loss was 1.1 g/dl. Mean hospital stay was 3.76 ± 0.93 days (range: 3 – 6 days). In our study, renal isotope showed that renal function did not change postoperatively. Conclusion: PNL is a safe and effective procedure for management of renal stones in children.