Recurrent and residual renal calculi in children

One hundred and thirteen children with non-metabolic urinary tract calculi were operated on between 1960 and 1983. One hundred were followed up for 3 to 17 years (mean 8.2). Seventeen children (15%) developed recurrent calculi after complete clearance at the initial operation and in 13 of these the stones recurred within 5 years. Proteus urinary infection was a constant feature of stone recurrence. Five patients required re-operation for removal of the recurrent calculus. Small residual caliceal fragments were left behind in 17 children but only 3 required surgical removal.     

Etiological and clinical patterns of childhood urolithiasis in Iraq

This study was conducted to evaluate the etiological and clinical characteristics of urolithiasis in Iraqi children. From 1999 to 2004, 204 children with renal calculi were evaluated. The age range of the patients was 4 months to 14 years, 61.3% of the patients were under 5 years. Male to female ratio was 2.8:1. The mean age at onset of symptoms was 3.2 years, and stone disease was diagnosed at a mean of 3.5 years. Hematuria (44.6%) and pain (28.4%) were the main clinical presentation. Of the 204 patients 45.1% had a family history of stones. Consanguinity was recorded in 72%; 75.5% had metabolic disorders. Stones were located at multiple sites in 80 patients, or 39.2%; 58 of these 80, or 72.5%, had metabolic disorders. Multiple stones were present in 47 (23%); 72.3% were related to metabolic disorders. In 126 patients, or 61.8%, both kidneys were involved equally. Bladder stones were found in 11.3%. Staghorn calculi occurred in 29 patients, or 14.2%; 27 of these had recurrent urinary tract infection (UTI). Nephrocalcinosis was diagnosed in 7, or 3.4%; all had metabolic disorders. Etiology of stone formation was established in 189 patients, or 92.6%, whereas 15, or 7.4%, had idiopathic stones. Metabolic disorders were the commonest cause in 106 patients (52%); 52 patients were classified as infective (25.5%). Anatomical defects were present in 25 (12.2%) and 6 children (2.9%) with primary endemic bladder calculi. Coexisting UTI was common (36.8%) in the metabolic group. We concluded that urolithiasis is a serious problem among Iraqi children, with early onset of presentation. Metabolic disorders were the major causes, but can be masked by associated UTI. Proper management of UTI with a careful metabolic assessment of young stone formers is valuable in combating urolithiasis.     

Percutaneous nephrolithotomy for treating renal calculi in children

OBJECTIVE: To report our experience with the percutaneous management of renal stone disease in children. PATIENTS AND METHODS: The medical and radiological records of children up to 18 years old who were treated for renal calculi by percutaneous nephrolithotomy (PCNL) at our institution between March 1995 and April 2003 were reviewed. For stone removal a special paediatric 18 F access sheath was used. RESULTS: In all, 26 PCNLs were used in 23 patients (10 boys and 13 girls, aged 1.7-16.8 years). The presenting symptoms were urinary tract infection, abdominal pain and/or haematuria. Of the 23 patients, 17 (75%) had associated metabolic disease or underlying urological anatomical abnormalities. Urinary tract infections were found in 15 patients (65%). The mean (range) stone burden was 6.0 (0.5-18.2) cm2, and the operative duration 127 (50-260) min. The primary stone-free rate was 58%, which increased to 81% after treating residual fragments. One blood transfusion was required and one patient developed urosepsis after PCNL, which was treated with antibiotics. CONCLUSION: PCNL is an effective alternative for treating renal stones in children, and is the treatment of choice for stones refractory to extracorporeal shock wave lithotripsy.     

Effect of potassium citrate therapy on stone recurrence and residual fragments after shockwave lithotripsy in lower caliceal calcium oxalate urolithiasis: a randomized controlled trial

BACKGROUND AND PURPOSE: To evaluate the efficacy of potassium citrate treatment in preventing stone recurrences and residual fragments after shockwave lithotripsy (SWL) for lower pole calcium oxalate urolithiasis. PATIENTS AND METHODS: One hundred ten patients who underwent SWL because of lower caliceal stones and who were stone free or who had residual stone 4 weeks later were enrolled in the study. The average patient age was 41.7 years. All patients had documented simple calcium oxalate lithiasis without urinary tract infection and with normal renal morphology and function. Four weeks after SWL, patients who were stone free (N = 56) and patients who had residual stones (N = 34) were independently randomized into two subgroups that were matched for sex, age, and urinary values of citrate, calcium, and uric acid. One group was given oral potassium citrate 60 mEq per day, and the other group served as controls. RESULTS: In patients who were stone free after SWL and receiving medical treatment, the stone recurrence rate at 12 months was 0 whereas untreated patients showed a 28.5% stone recurrence rate (P < 0.05). Similarly, in the residual fragment group, the medically treated patients had a significantly greater remission rate than the untreated patients (44.5 v 12.5%; P < 0.05). CONCLUSION: Potassium citrate therapy significantly alleviated calcium oxalate stone activity after SWL for lower pole stones in patients who were stone free. An important observation was the beneficial effect of medical treatment on stone activity after SWL among patients with residual calculi.     

Paediatric percutaneous nephrolithotomy: setting new frontiers

OBJECTIVE: To assess the safety and outcome of paediatric percutaneous nephrolithotomy (PCNL) for atypical cases and compare the results with 'standard' unilateral paediatric PCNL. PATIENTS AND METHODS: We retrospectively reviewed children who had had a PCNL between December 1997 and December 2004. Patients were grouped as follows: group 1, aged >5-16 years with normal anatomy and normal renal function undergoing unilateral PCNL or staged bilateral PCNL; group 2, < or = 5 years with normal anatomy and renal function undergoing unilateral PCNL; group 3, undergoing bilateral simultaneous PCNL; group 4, impaired renal function in addition to renal stone disease; group 5, renal anatomical abnormality with calculi in the same kidney. Demographics, stone profile, procedure and outcome indicators were analysed for each group. RESULTS: In all, 188 consecutive PCNLs in 169 children were included (mean age 3.3-10.3 years, mean stone burden 19.1-33.3 mm in the five groups). The mean duration of PCNL was 69-115 min. Stone clearance was satisfactory with single tract access in 90-100% of patients. Transient postoperative fever was the commonest complication (12.5-51%) followed by hyponatraemia and hypokalaemia. Blood transfusion was required in 0-7.7%. The mean stone clearance rates were 47-90% in the five groups; additional extracorporeal shockwave lithotripsy increased the cumulative clearance rates to 90-100%. CONCLUSION: PCNL is safe for treating renal stones, with excellent results and minimal complications. Comparable results are achieved in the very young child, children with anatomically abnormal kidneys, children with impaired renal function and children with bilateral renal stones undergoing simultaneous bilateral PCNL. Hence none of these factors should be considered as relative contraindications.     

Assessment of risk factors of pediatric urolithiasis in Egypt

Objective

Pediatric urolithiasis is a significant medical problem, which has seen an increasing incidence in developing countries. The main objective of the present study was to investigate the clinical characteristics and the most important risk factors that contribute to stone formation in Egyptian children.

Patients and methods

This prospective study was carried out at the outpatient clinics of Cairo university children’s hospital as well as October 6 University hospitals, between November 2008 and March 2012. One hundred and fifty children (100 males, 50 females; mean age 3.5 years; range, 1-14 years) suffering from urinary stones were included. The mean follow-up duration; 33.1 months. All patients underwent detailed medical and family histories, dietary habits and physical examination, including Growth percentiles. Laboratory investigations were performed including: complete urine analysis and culture and sensitivity tests, urine collection in 24-h to quantity urinary volume, pH, calcium, uric acid, magnesium, creatinine, oxalate and citrate. Blood samples were obtained to measure (serum creatinine, calcium, phosphorus, uric acid level, and alkaline phosphatase and electrolyte levels, in addition to pH and pCO₂ values). Radio-sonographic investigation of the abdomen and pelvis was also performed.

Results

The commonest presentations were abdominal pain in 42 children (28%) and gross hematuria in 35 patients (23%). Urinary tract infection was the most common risk factor, 60 patients (40%) had UTI, 70% of them had recurrent infections. Genito-urinary abnormalities, as a risk factor, were detected in 38 children (25%), with vesico-uretheral refux being the commonest abnormality (18/38). Metabolic risk factors were detected in 34 children (23%) with hypercalciuria and hyperoxaluria being the commonest metabolic abnormalities. Treatments used were, ESWL in 69 patients (46%), endoscopic interventions in 40 children (27%) and open surgery in 15 children (10%). The remaining 26 children (17%) were managed conservatively.

Conclusions

treatment of pediatric urolithiasis requires stone removal besides a thorough metabolic and environmental evaluation of all patients on an individual basis, entailing the treatment of metabolic abnormalities. Children with a positive family history should be followed up cautiously to avoid stone recurrence.     

Percutaneous removal of renal and ureteral calculi in 104 patients

One hundred and four consecutive patients with renal and/or ureteral calculi, 66 males and 38 females with an average age of 44.3 years ranging from 17 to 83, were treated by a percutaneous procedure between September, 1984 and October, 1987. In an early series of 6 patients, a two-stage procedure consisting of temporary renal drainage and the introduction of an endoscope a few days later was employed. The remaining 98 patients received a so-called one-stage procedure. The stone was removed successfully in 96 patients with an average operation time of 140 minutes. In 2 of the 96 patients, renal stones recurred 7 months and 20 months later. The most common cause for failure in stone removal was the difficulty of engaging calyceal stones and ureteral stones using a basket and/or 3-prong grasper, because of inflammatory mucosa adhering to the stones. Out of 8 failures, 7 and 1 required an open operation and trans-urethral intervention, respectively. There were 40 complications in 33 patients. Of 11 patients in whom renal pelvic perforation occurred, 2 required open surgical repair. Of 5 patients complaining of renal bleeding, 1 required renal artery embolization. With increasing experience and improving procedure, most renal, and upper and mid ureteral stones have been safely and successfully removed percutaneously.     

Percutaneous nephrolithotomy in children before school age: experience of a Pakistani centre

OBJECTIVE: To review our experience of percutaneous nephrolithotomy (PCNL) in children before school age, and determine its efficacy and safety in this age group. PATIENTS AND METHODS: The records of children aged < or = 5 years undergoing PCNL were reviewed. Variables assessed included stone number, size, location and type. The PCNL puncture site and number were also recorded. We reviewed stone clearance with PCNL, ancillary procedures used, complication rates and follow-up status of the children. RESULTS: There were 30 renal units in 29 children (median age 3.8 years, range 1.4-5). Because of poor growth the mean (SD) body weight of the children was only 12.2 (2.8) kg, which is near the 50th percentile for children of mean age 3.5 years. The median (range) stone burden was 2.35 (1.3-6) cm; 60% of the patients had single stones while 28% had more than five. There were five staghorn stones. All PCNL was primary and with one puncture, using a 17 F angled nephroscope; stones were fragmented using a pneumatic lithoclast. After PCNL stones were completely cleared in 60% of the renal units, which increased to 100% after combining it with extracorporeal shockwave lithotripsy. The median (range) follow-up was 24.9 (4-51) months; the overall complication rate was 6%. In the long follow-up hypertension was not detected in any child and isotopic renograms in 17 kidneys detected no new scarring or loss of renal function. CONCLUSION: PCNL is a safe and effective for treating renal stones in very young children.     

Causes and consequences of kidney loss in patients with nephrolithiasis

BACKGROUND: It is unknown whether stone formers may safely donate a kidney. Nephrectomy could accelerate stone formation, or loss of filtration with age. We contrast, here, the course of stone patients with two versus one kidney. METHODS: One hundred fifteen patients with a single functioning kidney were compared with 3151 patients with two kidneys. Cause of kidney loss was determined, along with stone types, rates of stone formation, urine stone risk factors, and creatinine clearance. RESULTS: Women were 49.6% of the patients with kidney loss, compared to 33.6% of ordinary stone formers. Obstruction, stone burden, and infection were the most common reasons for kidney loss. We found an increased number of struvite and calcium phosphate stones among single kidney patients. Before and during treatment, single kidney patients had fewer stones than ordinary stone formers. Creatinine clearance was lower in the single kidney patients; rate of loss of kidney function with age was higher among single kidney males versus two kidney males if all patients are considered. Among males >age 45 years, the difference disappears. Females with one and two kidneys lost function with age at equivalent rates. Compared with nonstone formers, male stone formers lose kidney function with age at an accelerated rate. CONCLUSION: Nephrectomy does not worsen stone disease. It may increase loss of renal function among younger males. The pattern of renal function loss with age differs between stone formers and nonstone formers.     

The aetiological and clinical pattern of childhood urolithiasis in Saudi Arabia

The clinical and aetiological pattern in 85 stone-forming children presenting to an integrated nephrourological service in Riyadh is reviewed. All patients were below the age of 15 years, the male to female ratio being 2∶1. Only 2 children presented with bladder calculi. The remaining all had upper tract stone and, in 12 cases, these were bilateral. Of 34 calculi recovered for analysis, one-third was predominantly calcium oxalate and a further third was composed of uric acid or urate. Four patients had cystine stones and the remaining 7 presented mixed calcium stones, 6 (17.6%) being struvite and infection-related. Of the 85 patients 55 were treated successfully with extracorporeal shock wave lithotripsy, 16 underwent surgery and 7 had their stones removed by endourological procedures. In the remaining 7 children, stones dissolved or were passed spontaneously during medical therapy. Nine children (10.6%) showed a primary metabolic defect leading to their stone formation, 10 (11.8%) had a predisposing anatomical anomaly and 15 (17.6%) presented with urinary tract infection. Of the remaining 51 patients (60%) with idiopathic disease, 6 showed hypercalciuria on investigation and 2 children may have formed their stones due to prolonged recumbency.     

Retrograde intrarenal surgery for the treatment of renal stones in children: Factors influencing stone clearance and complications

Background

Retrograde intrarenal surgery (RIRS) is a known option for the treatment of upper tract calculi with an excellent success. However, the reports of RIRS in prepubertal children are limited. In this study, we evaluated the factors which affected the success rate and the complications of RIRS at renal stone treatment in childhood.

Methods

We retrospectively reviewed the records of children under 14 years old who underwent RIRS for renal stone disease between January 2009 and December 2012. Patients’ age, gender, body mass index (BMI), stone size, stone location, stone number, intraoperative complications, stone free status, postoperative complications were recorded.

Results

There were 80 ureterorenoscopic procedures performed in 58 renal units of 47 children (23 males and 24 females). The patients’ ages ranged from 8 months to 14 years (mean age 4.7 ± 3.4 years). There was a difference in the distribution of symptoms in age groups. UTI was higher in the 1–4 years age group, abdominal pain was seen mostly in children aged 5–14 years. Multiple stones (included staghorn stone) were noted in 60.4% of patients. In 27.6% of patients, ureteral stones were accompanied by renal stones in our series. In the infancy group, cystine and staghorn stones were more frequently seen, mostly bilateral. After a single ureteroscopic procedure for intrarenal stones in children, we achieved stone free status in 50.9% of the ureters (n = 26). After the repeated sessions, the stone clearance rate reached to 85.1%.

Conclusion

Retrograde intrarenal surgery can be used as a first line therapy to treat renal stones in children. This is especially important if an associated ureteral stone is present that requires treatment; or in patients with cystinuria, which is not favorably treated with ESWL. Complications were seen more frequently in patients with cystine stones. Extravasation was noted more frequently in patients admitted with UTIs. There was a significant relationship between the conversion to open procedures and the age groups, with most procedures occurring in infancy. The parents should be informed about the probability of multiple procedures to achieve stone free status.     

Effect of potassium citrate therapy on stone recurrence and regrowth after extracorporeal shockwave lithotripsy in children

BACKGROUND AND PURPOSE: Stone disease in children may cause functional and morphologic changes in the urinary tract during longer-term follow-up. Prevention of stone recurrence will be possible only with careful metabolic evaluation and appropriate management. The possible preventive effects of potassium citrate therapy on true stone recurrence, as well as regrowth rates after shockwave lithotripsy (SWL), were evaluated in children treated for renal stones. PATIENTS AND METHODS: Following assessment of the efficacy of SWL, 96 children (72 male, 53 female aged 4 to 14 years with a mean of 6.6 years) were evaluated for the effects of potassium citrate on residual fragments as well as true new stone formation during long-term follow-up. All children had calcium-containing stones with normal renal morphology and function without any urinary-tract infection. Depending on the outcome of treatment, patients with and without residual stones were allocated independently to Group I (N = 52) and Group II (N = 44), which were matched for sex and age. Group I was given oral potassium citrate 1 mEq/kg daily for 12 months; the remaining children served as controls. Follow-up ranged from 12 to 36.6 months, with a mean of 24.4 months. Follow-up results for at least a year with respect to the stone recurrence or stone growth rates were recorded in both groups. RESULTS: Stone-free children undergoing no specific therapy had significant new stone formation compared with the group receiving potassium citrate on a regular basis (34.6% and 7.6%, respectively). Children with residual fragments receiving no specific preventive measure also showed significant new stone formation, along with enlargement of the fragments. CONCLUSION: In addition to stone removal, treatment of pediatric urolithiasis requires a thorough metabolic evaluation. Depending on the abnormalities, each patient should be advised on adequate drinking to increase the urine volume in accordance with body size. Although children with hypocitraturia may well benefit from therapeutic agents that raise the urine citrate concentration, our results did clearly show that all children bearing residual fragments should be counseled on adequate fluid intake along potassium citrate treatment to prevent stone regrowth or formation during long-term follow-up.     

Percutaneous renal and ureteric stone extraction. Report on the first 500 operations

A consecutive series of the first 500 percutaneous renal and ureteric stone extractions in 451 patients was analysed. During the period studied, percutaneous extraction was offered to all patients with conventional indication for stone removal except a few, very early ureteric stone patients in whom open lithotomy was carried out. Ureteroscopy and extracorporeal shock wave lithotripsy had not come into routine use. Four hundred and seventy-eight stone operations (96%) could be performed by the percutaneous route; early in the series, 21 open operations and one transurethral Dormia basket extraction were performed, mainly because of failed mobilisation of ureteric stones (12 patients) or various peroperative complications (9 patients). The target stones were completely removed in 88% of all percutaneous procedures, with the best results in the largest group of patients with 6-20 mm solitary stones or 2-3 stones less than or equal to 10 mm. Stones in the ureter and pelvi-ureteric junction without any other concomitant stones were all completely removed. Bleeding was the most frequent peroperative complication. No kidney was lost. An 84-year-old man died of intercurrent disease postoperatively.     

Pediatric urolithiasis--evaluation of risk factors in 95 children

OBJECTIVE: Pediatric urolithiasis is a rarely encountered pathology, except in endemic areas such as Turkey. As a recurrent pathology which may reveal functional as well and morphologic changes in the urinary tract, metabolic and environmental factors, in addition to urogenital abnormalities, should be evaluated thoroughly in each patient. In this prospective study, the patient and family histories of 95 children with stone disease were evaluated, together with serum and urine risk factors. MATERIAL AND METHODS: Between 1996 and 2001, 95 children (25 females, 70 males; mean age 7.3 years; age range 0.6-15 years) referred to our department with urolithiasis were evaluated. All patients were investigated with respect to stone localization, associated abnormalities, urinary tract infection (UTI), positive family history and serum and urine risk factors. In addition to standard risk factors (hypocitraturia, hypercalciuria, hyperoxaluria, hyperuricosuria, hypomagnesuria), diet and 24-h urine volume were also assessed in all children. Children with cystinuria were excluded from the study. RESULTS: Stone size ranged from 0.3 to 3.3 cm, with an average value of 2.0 cm. The localization of the stones was classified as unilateral single stone in 37 patients, multiple unilateral stones in six and bilateral multiple stones in 27. Hypocitraturia was the commonest risk factor detected in our patients. A positive family history was present in 51 cases (54%). In addition, UTI was present in 59 cases (62%) and 67 cases had a previous history of recurrent UTI. Associated urogenital abnormality was detected in nine cases (9.4%). There were significant correlations between stone size and urinary citrate excretion (p < 0.05) and between the presence of UTI and urinary phosphate excretion (r = 0.59, p = 0.047). Treatments used were open surgery in seven (7.3%) cases, extracorporeal shock-wave lithotripsy in 39 (41%) and endoscopic surgery in 20 (21%). Following these procedures, 39 (41%) patients were completely stone-free, 11 (11%) had residual stones (<5 mm in diameter) and 12 (14.8%) passed the stone(s) spontaneously. During follow-up, regrowth was seen in four (4.2%) patients and stone recurrence was noted in a further four (4.2%). CONCLUSIONS: In addition to stone removal, treatment of pediatric urolithiasis requires a thorough metabolic and environmental evaluation of all patients on an individual basis. Obstructive pathologies have to be corrected immediately and apparent metabolic abnormalities should also be treated. Children with a positive family history should be followed carefully with respect to stone recurrence. Urine volume increases in parallel with body mass index and medical therapeutic agents which increase urine citrate levels should be encouraged.     

Percutaneous nephrolithotomy. A report of 150 cases

One hundred and fifty patients with renal stones have been treated by percutaneous nephrolithotomy. Complete stone clearance was achieved in 130 cases (87%). The management of patients in whom stone removal was not achieved percutaneously and the complications of the procedure are discussed. Guidelines are set out for successful percutaneous nephrolithotomy.     

A study on the passage of the upper urinary tract stones after in situ ESWL]

Two hundred patients with upper urinary tract stones underwent in situ ESWL with Lithostar during the recent 20 months at Kanagawa Prefectural Atsugi Hospital. Actual residual stone rates were calculated based on the period from the initiation of the treatment to the stone free status, and discussed according to the location and size of the stone treated. Total 200 patients were submitted to 1.67 +/- 0.97 treatment sessions with 6742 +/- 5545 shock waves. After 3 months, 148 patients (78%) showed stone free status, and 32 patients (16%) had residual stones less than 4 mm. The actual residual stone rates were 90.5%, 66.5%, 39.1%, 26.9% and 17.9% after 1, 3, 6, 12 and 20 weeks, respectively. The residual stone rate were lower in the lower ureter, uretero-pelvic junction, upper ureter, renal parenchyma or diverticulum and renal pelvis or calyx in order. As for the size, the larger the stones the higher the residual stone rates; the therapeutic results were significantly worse in patient group of stones larger than 21 mm compared to the patient group of smaller stones (p less than 1%). The destructed stones were passed gradually up to 6th week after in situ ESWL, however, after that fragments seldom passed out. Therefore, it was concluded that decision on the additional or combination therapeutic intervention, if necessary, should be made after 6 weeks. Combination therapy with endoscopic surgery and/or others was seemingly needed for the patients with stones of more than 21 mm in size and of renal pelvis and renal calyx to improve the rates of stone free.     

Some features of paediatric urolithiasis in a group of Syrian children

A group of 28 Syrian children (19 males and 9 females; age ranging from 2.5 to 12 years) were diagnosed clinically and radiologically to have upper urinary tract stones. The commonest presentations were renal colic, vomiting, haematuria, pyrexia and vague abdominal pain. Family history of renal stones was present in 21% of cases. Haematological picture and chemical analysis of blood were within the normal limits for their age and sex. Urine analysis, however, showed significantly marked increase in the 24-hour excretions of calcium and uric acid. Microscopic examination showed haematuria and pyuria in 72% of the children with urolithiasis. Chemical analysis of removed stones revealed that most of them were mixed stones of calcium oxalate and urate or/and phosphate. Pure stones of calcium oxalate or calcium phosphate were less common. Radiologically, about 95% of all stones were demonstrated by plain X-ray, while 5% only after IVP.     

The effect of intracalyceal distribution on the clearance of renal stones of > or = 20 mm in children after extracorporeal lithotripsy

OBJECTIVES: To determine the effect of the intracalyceal distribution of renal stones on clearance rates after treating paediatric nephrolithiasis with extracorporeal shock wave lithotripsy (ESWL). PATIENTS AND METHODS: We assessed a retrospective case series of children (aged < or = 14 years) undergoing lithotripsy on an MPL 9000 (Dornier GmbH, Germany) echo-guided lithotripter. Patients were identified using an international coding and indexing system and ESWL registry. In all, 125 children were treated during 1990-2003, but 21 had stones of > or = 20 mm. Stone clearance was assessed at 1 and 3 months, the stone-free state being defined as no radiological evidence of stone or fragments of < or = 3 mm. Failed treatments were analysed to identify any correlation with stone site. RESULTS: The overall stone-free rate was 81%; in four children the treatment failed (all girls) and subsequently they required ancillary procedures. Nineteen patients (90%) received up to three sessions of ESWL; two required four or more sessions. Of the four children in whom treatment failed, two had JJ stents; the stones were in the lower pole calyx in two, and the renal pelvis and lower pole calyx in two. The mean stone size in those where treatment failed was 25 mm, vs 21 mm in the stone-free group. The complication rate was 19%, but only one child required admission to hospital. CONCLUSIONS: ESWL is very effective for renal stones in children, with minimal morbidity. Lower pole and partial staghorn stones with a major component in the lower pole calyx should preferably be treated by a percutaneous approach.     

Metabolic and demographic characteristics of children with urolithiasis in Western Turkey

Pediatric urolithiasis is an endemic disease in Turkey. We evaluated the clinical, radiological and metabolic features of children with urolithiasis in Western Turkey. We retrospectively reviewed the records of 85 children with urolithiasis who were followed-up between 2004 and 2010 in Pediatric Nephrology Department of Celal Bayar University, Manisa. The male/female ratio was 1.23/1. The mean age at diagnosis was 66.1 months (range 3–210 months). Family history of urolithiasis was found in 58 (68.2%) patients. 23 (27%) patients were born from consanguineous marriages. Stones were located in the upper urinary tract in 79 (92.9%) patients. In 66 (77.6%) patients, stones were single-sided and 41 (48.2%) patients had multiple stones. Calcium oxalate stones were the most common one among patients in whom stone analysis was performed (78.5%). Hypocitraturia was the most commonly detected urinary metabolic risk factor. In patients who were under 12 months of age at diagnosis, hypercalciuria was the most commonly seen urinary metabolic risk factor. At the end of follow-up period, 24 patients became free of stone disease and 4 patients had recurrence. In conclusion, metabolic abnormalities are common in pediatric stone patients and are strongly associated with recurrence. Considering that urolithiasis in children is an important risk factor for renal failure, early diagnosis, detailed metabolic evaluation and implementing appropriate treatment and follow-up protocols may prevent recurrence and renal damage.     

Extracorporeal surgery and autotransplantation for complicated renal calculous disease in 108 kidneys

One hundred and eight kidneys in 97 patients with staghorn (72%) or multiple pyelocalyceal (28%) calculi were treated by extracorporeal surgery and autotransplantation, and followed up for 1-12 (mean 3) years. Twenty-seven patients had a solitary kidney, and 11 were operated on bilaterally. Sixty-nine % had a history of previous stone surgery, 74% had urinary tract infection and 30% renal dysfunction. Postoperative and late mortality rates were 3.1 and 2.1%, respectively. In addition, three kidneys were lost postoperatively and two later. Only one case of renal calculus recurrence was observed. Sixty-nine per cent of preoperatively infected patients were cured of infection, and 18% improved. Ninety-two per cent of patients with functioning autograft had preserved or improved renal function at follow-up. We find extracorporeal calculus removal a highly effective procedure with an acceptable risk.