Extracorporeal shock wave lithotripsy in children

Extracorporeal shock wave lithotripsy has proved to be an effective method of treating upper urinary tract calculi. We report on 14 patients 17 years old or younger who were treated with the Dornier lithotriptor. Special adjustments of the gantry and water level, as well as shielding of the lungs, were necessary in those children less than 135 cm. in height or 30 kg. in weight. Hospital stay averaged 2.5 days and ranged from 1 to 6 days. There were no major intraoperative complications. Postoperative pulmonary edema developed in 1 patient and only 3 required parenteral analgesics for postoperative pain control. Of the 12 patients for whom a 3-month followup is available 10 are free of stone. One patient required ureterolithotomy for removal of impacted stone fragments. We conclude that extracorporeal shock wave lithotripsy is a safe and effective method of treating renal calculi in children.     

Renal stones in children in Pakistan

One hundred and fifty children up to the age of 12 years with documented evidence of renal or ureteric stones were studied between July 1973 and June 1983. The peak age group was between 10 and 12 years, the male to female ratio being 1.9:1. Abdominal pain was the commonest presenting symptom (66.6%). Asymptomatic stones or vague symptoms in 23 patients warrant a higher index of suspicion of renal stone disease in children. Thirty patients had associated renal insufficiency. One third of the children had a positive urine culture, Proteus spp. being the commonest organism. Congenital anomalies of the urinary tract were seen in 12% of patients. In the majority (59%), aetiological factors related to stone formation could not be identified. One hundred and thirty patients underwent surgery for removal of stones. Analysis of calculi by X-ray diffraction and infrared spectroscopy revealed that stones were predominantly of mixed type, calcium oxalate being the commonest compound. The overall recurrence rate following surgical removal was 15%.     

Childhood urolithiasis in Iran with special reference to staghorn calculi

Between 1972 and 1984 148 children with urolithiasis were studied and managed at the University Clinic Children's Hospital of Teheran. In 125 children the calculi were in the upper and in 23 children in the lower urinary tract. The maximum incidence was between the ages of 5-8 and 12 years. 25 children had malformations and 16 had metabolic disorders. Cystinuria was observed in 6 and xanthinuria in 3 cases. The main constituents of calculi analyses in the upper urinary tract were calcium oxalate followed by ammonium acid urate. In the lower urinary tract ammonium acid urate and oxalate were seen with equal frequency, followed by uric acid. 16 children had staghorn calculi with an age profile of 5-13 years. Predominant symptoms were flank pain and gross hematuria. In 4 cases the calculi were bilateral. The calculi were removed successfully by pyelotomy and extensive pyelolithotomy. In 2 cases with more branched-out staghorn calculi and separate fragments, a logitudinal extensive nephrotomy was performed. In the absence of recurrent stones, renal growth and function were satisfactory postoperatively. In the majority of the cases the analyses of the staghorn calculi revealed phosphate.     

经膀胱镜输尿管双J管置入治疗小儿上尿路梗阻

目的探讨经膀胱镜留置输尿管双J管在小儿上尿路梗阻中的应用价值。方法回顾性分析2014年12月~2018年5月45例膀胱镜输尿管双J管置入治疗上尿路梗阻的资料,其中先天性肾积水20例,急性输尿管结石梗阻23例,肾盂离断成形术后积水复发2例。均经膀胱镜逆行置入F3、F4或F4.7双J管。结果2例先天性肾积水和3例急性输尿管结石梗阻未能置入输尿管双J管,其余40例留置双J管位置良好。先天性肾积水18例均于术后6个月取出双J管,8例随访3~4年积水未加重,10例因积水加重行腹腔镜肾盂离断成形术;急性输尿管结石梗阻20例于1~2周拔除输尿管双J管,二期输尿管镜钬激光碎石成功;肾盂离断成形术后积水复发2例均于术后6个月拔除输尿管双J管,1例随访1年5个月肾积水无再次加重,1例因肾积水再次加重于拔管后20天行腹腔镜肾盂离断成形术。结论输尿管双J管置入可有效缓解小儿上尿路梗阻,达到缓解肾脏压力的目的,可作为婴幼儿和儿童上尿路梗阻的一线治疗方案。     

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.     

Caliceal calculi

Primary nonobstructive caliceal calculi were removed by nephrostolithotomy in 51 patients. Among the patients with caliceal stones indications for removal included pain in 36 (71 per cent), associated infection in 11 (21 per cent), progressive stone growth in 2 (4 per cent), hematuria in 1 (2 per cent) and flight status eligibility in 1 (2 per cent). Over-all, 300 patients have undergone percutaneous removal of upper urinary tract calculi, with a 97 per cent success rate. Successful removal was completed percutaneously in 49 patients (96 per cent). One patient remains asymptomatic with retained caliceal fragments and surgical stone removal was required in 1 additional patient. Complications occurred in 4 patients (8 per cent). One patient underwent transcatheter embolization of an intralobar artery to control renal bleeding. Three patients required placement of an internal Double-J ureteral stent to permit resolution of ureteral edema. Following recovery 34 of 36 patients (95 per cent) reported complete resolution of the preoperative pain for which the calculus was removed. Two patients had persistent urinary infection. The remaining patients reported no residual complaints. These observations suggest that pain and discomfort occasionally may be associated with nonobstructive caliceal calculi. Removal of caliceal calculi may permit resolution of associated discomfort in more than 90 per cent of all carefully selected patients.     

输尿管软镜钬激光碎石术治疗婴幼儿上尿路结石

目的探讨输尿管软镜联合钬激光治疗婴幼儿（<2岁）上尿路结石的可行性与有效性。 方法回顾性分析我科自2016年1月至2018年2月应用输尿管软镜治疗婴幼儿上尿路结石62例（77侧）。其中男37例,女25例,均为维吾尔族,年龄8～24个月,单侧上尿路结石47例,双侧上尿路结石15例。输尿管上段结石19侧,肾盂结石31侧,肾上盏结石18侧,下盏结石9侧,结石最大径8～25 mm。所有患儿均Ⅰ期置入双J管被动扩张输尿管2周,Ⅱ期采用导丝引导下直接置入输尿管软镜,配合200 μm钬激光光纤碎石,激光功率为20～30 W,术后留置双J管2～3周。 结果62例均入镜成功,51例行一次碎石手术（双侧上尿路结石6例）,9例双侧上尿路结石行两次碎石手术,2例下盏结石未能寻及继续观察。术后住院3～5 d,术后8周复查67侧结石排尽,结石清除率87.0%（67/77）,平均手术时间为35 min（20～55 min）。 结论输尿管软镜联合钬激光碎石治疗婴幼儿上尿路结石,有较高的清石率和临床安全性。     

Vesicostomy revisited: the best treatment for the hostile bladder in myelodysplastic children?

OBJECTIVE: To evaluate the effects of vesicostomy on the urinary tract of myelodysplastic children in whom conservative bladder management with clean intermittent catheterization (CIC) has failed to preserve upper and lower urinary tract function. PATIENTS AND METHODS: Sixteen children with myelodysplasia underwent vesicostomy. Indications included worsening hydronephrosis, vesico-ureteric reflux (VUR), recurrent urinary tract infections (UTIs), and increasing renal insufficiency despite CIC and/or difficulty with CIC. The mean (range) age at vesicostomy was 36.5 (9-82) months and the follow-up 7.4 (2-16) years. RESULTS: Hydronephrosis resolved or improved in 12 of 14 children, the incidence of UTI decreased to one or fewer per year in 10, VUR resolved or improved in nine, and renal function improved or stabilized in six of seven patients. One patient initially presented with renal insufficiency and subsequently required dialysis despite vesicostomy. Complications occurred in three of 15 children, and included stomal stenosis and bladder calculi. The vesicostomy was closed in six patients after a mean of 4.4 (1.5-9) years. Four of these patients required concomitant bladder augmentation. CONCLUSIONS: Vesicostomy in myelodysplastic children is effective in preventing and/or resolving the deleterious consequences of a 'hostile' bladder. The procedure is uncomplicated, well tolerated, reversible and should be considered in managing children in whom conservative management by CIC has failed.     

Electromagnetic extracorporeal shock wave lithotripsy in children

Extracorporeal shock wave lithotripsy (ESWL) was performed for the treatment of urinary tract calculi in 28 children. All treatments were done with the standard Siemens Lithostar device in situ: no special adaptations for adequate positioning of children are required to target the stone precisely. A total of 42 calculi in 30 renal units was treated, requiring 50 ESWL sessions. The mean energy used was 16.4 kv. and the number of shock waves averaged 3,188. Mean fluoroscopy time per session was 1.5 minutes. In 26 of 50 sessions (52%) general anesthesia was needed for the child to remain perfectly still. A complete stone-free rate was achieved in 38 of 42 calculi (90.5%): after 1 session in 30 (71.4%), after 2 sessions in 6 (13.7%) and after 3 sessions in 2 (4.8%). Five staghorn calculi were treated with ESWL monotherapy. A complete stone-free result was obtained after 3 treatments in 2 patients, while 2 had residual fragments in the lower pole (5 mm. after 6 sessions and 11 months of followup in 1, and 7 mm. after 3 sessions and 3 months of followup in 1). A cystine staghorn stone necessitated open nephrolithotomy after 3 sessions without any fragmentation. One impacted sacroiliac ureteral stone required endoscopic laser lithotripsy. Except for these 2 failures no adjuvant procedures were needed. There were no intraoperative or postoperative complications and minor skin bruising at the coupling site after 3 treatments did not require any therapy. We conclude that electromagnetic ESWL with the standard Lithostar unit is a safe and effective method to treat calculi throughout the urinary tract in children.     

体外冲击波碎石治疗尿路结石15467例临床分析

目的探讨腔镜时代体外冲击波碎石（ESWL）治疗尿路结石的价值。方法回顾性分析1988年8月至2012年12月15467例尿路结石患者行ESWI。治疗的临床资料,其中包括儿童尿路结石85例,移植肾结石46例,腔镜及手术后结石残留506例。治疗后3个月随访。结果经3个月随访,结石总排净率为86．7％。1次粉碎11708例,碎石率为75．7％;复治3759例,复治率24．3％。ESWL治疗后辅助措施333例（2．2％）。结论目前即使有先进的腔镜取石方法,ESWL仍然是治疗尿路结石最主要方法之一。     

学龄前儿童尿路结石的腔内治疗

目的 评价学龄前儿童尿路结石腔内治疗的疗效与安全性.方法 2004年8月至2008年8月,28例学龄前尿路结石患儿接受腔内治疗,其中11例输尿管结石患儿接受输尿管镜取石术,17例肾结石患儿接受微创经皮肾镜取石术.结果 11例输尿管结石患儿中,5例一期输尿管镜取石术,6例一期输尿管置管被动扩张1～3周后二期8/9.8 Fr输尿管硬镜下取石成功;17例肾结石患儿均一期微创经皮肾镜取石术.结论 对有手术指征的学龄前儿童尿路结石,采用微创腔内治疗是安全可靠的.     

Urinary calculi in renal transplant recipients

Urinary calculi are an uncommon complication in renal transplant recipients. During a 15-year period, in 544 cases of kidney transplantation with a functioning allograft for more than 3 months, and a long-term follow-up, we have observed 9 cases (1.7%) of urinary calculi. Calculi occurred in 6 male and 3 female patients, 6 patients were recipients of living related and 3 of cadaveric kidneys. Calculi were diagnosed as early as 3 months and as late as 3.5 years after transplantation, but most were detected within the first year. The location of the calculi was the bladder in 4 cases, the transplant in 3, and indeterminant in 2. Crystallographic analysis of retrieved stones revealed calcium oxalate and/or phosphate in 4 cases, triple phosphate in 2, and uric acid in 1. All patients had one or more stone-predisposing factors, such as obstructive uropathy and recurrent urinary tract infection (4 cases), hyperoxaluria (3), or hypercalciuria (2). During long-term follow-up (mean 60 months), only one patient lost the renal graft, 14.5 years after transplantation, primarily from causes unrelated to urinary calculi. One instance of stone recurrence was noted. In conclusion: (1) urinary calculi after renal transplantation are relatively uncommon; (2) predisposing factors and crystallographic composition of the calculi are identical in type, but not frequency, to those of nontransplant patients; and (3) with proper medical and surgical management, post-transplant urolithiasis does not appear to affect graft prognosis.     

Extracorporeal shockwave lithotripsy monotherapy for paediatric urinary tract calculi

The role of extracorporeal shockwave lithotripsy (ESWL) in the management of paediatric urinary tract calculi was evaluated. The study group included 22 children (13 male, 9 female) with an age range of 2 to 13 years. The renal calculi, including staghorn and ureteric calculi, varied in size from 0.3 to 5 cm. Overall stone clearance at 3 months was 79% with a low incidence of complications (2 children required nephrostomy drainage for sepsis). ESWL is a non-invasive method of managing even complex stones in children of all ages, irrespective of size or position.     

Extracorporeal shock wave lithotripsy in children: Results and short-term complications

AIM: The introduction of extracorporeal shock wave lithotripsy represented an important evolution in urinary tract lithiasis management. The aim of this study is to describe the results of extracorporeal shock wave lithotripsy for the treatment of urinary tract lithiasis in children, focusing on the index of elimination of the calculi and the complications occurring during the procedure and during the following three months. METHODS: From September 1991 to July 2002, 135 children between one and 12 years, suffering from urinary tract lithiasis underwent extracorporeal shock wave lithotripsy. A retrospective analysis of these patients was carried out. RESULTS: One hundred and ninety-five calculi ranging in size from 5.0 mm to 20.0 mm were treated, out of which 147 were found in the kidneys and 48 in the ureter. Urinary tract dilation was presented by 30% of the children at the time of the procedure. After extracorporeal shock wave lithotripsy 75.8% of the calculi were eliminated: 64.1% were stone-free and 11.7% had < or = 4 mm stones. Ureteral calculi and 5-10 mm stones responded better than the kidney and 11-20 mm stones (P = 0.027 and P = 0.012, respectively). No differences were detected according to the calculi location, whether in the ureter or kidney (P = 0.637 and P = 0.703, respectively). The shock wave intensity of 14kv was as efficient as the higher voltage. Short-term complications were observed in 23.7%, characterized by fever and pain. CONCLUSION: In children, extracorporeal shock wave lithotripsy proved to be able to eliminate 75.8% of the treated calculi and 83.7% of the patients presented a complete or partial response. Complications were observed in 23.7% of patients, and pain was the most frequent symptom.     

Extracorporeal shock wave lithotripsy: the Methodist Hospital of Indiana experience

A total of 982 patients underwent 1,416 treatments with extracorporeal shock wave lithotripsy for upper urinary tract calculi between February 23 and December 17, 1984. A single treatment was performed in 90 per cent of the patients. Morbidity was extremely low and hospital stay was short (3.0 days). Adjunctive procedures were required in 13 per cent of the patients. Of the kidneys 72 per cent were free of stones at the 3-month followup, while 23 per cent contained small (less than 5 mm.), asymptomatic fragments believed to be passable spontaneously. Only 1 per cent of the patients required surgical removal of the calculi. Morbidity was related directly to stone burden, while results were inversely related to stone burden. Extracorporeal shock wave lithotripsy is the preferred form of management for symptomatic upper ureteral and renal calculi less than 2 cm. in diameter.     

体外冲击波碎石治疗儿童尿路结石的疗效观察(附62例报告）

目的：探讨体外冲击波碎石(ESWL)治疗儿童尿路结石的有效性和安全性。方法：采用ESWL治疗儿童尿路结石患者62例，其中肾盂肾盏结石35例，输尿管结石22例，膀胱结石4例，移植肾结石1例。结果：62例随访3个月，结石排净59例(95．2％)，结石残留2例(3．2％)，1例无效(1．6％)，改用手术治疗。结论：ESWL治疗儿童尿路结石安全、有效，是儿童尿路结石的首选治疗方法。     

Aetiology of nephrolithiasis in north Indian children

The aetiology of nephrolithiasis was investigated in 32 north Indian children (25 boys, 7 girls, mean age 7.9±3.3 years). An underlying disorder was detected in 16 (50%) patients and included idiopathic hypercalciuria (8 patients), hyperoxaluria (3 patients) and renal tubular acidosis, primary hyperparathyroidism and hyperuricosuria (1 patient each). Magnesium ammonium phosphate calculi were found in 2 patients with recurrent urinary tract infections, 1 of whom had a duplex pelvic collecting system. In 16 patients (50%) a cause for renal calculi was not identified. Our findings suggest that an underlying disorder is present in a large proportion of children with nephrolithiasis where appropriate treatment may be beneficial.     

Treatment of 2019 cases with upper urinary tract calculi using a piezoelectric lithotriptor ESL-500A

PURPOSE: We evaluated the results of extracorporeal shock wave lithotripsy (ESWL) in a large number of cases with upper urinary tract calculi, and reported the strategy how to improve the efficacy and safety of ESWL. PATIENTS AND METHOD: Eight hundred fifteen patients with renal calculi and 1,204 patients with ureteral calculi were treated using a piezoelectric ultrasound-guided lithotriptor, Toshiba ESL-500A. Auxiliary measures were needed in 51 cases (2.5%) and 1,968 cases (97.5%) were treated by in situ procedures. ESWL was performed with the optimal positioning of the patient and under the continuous monitoring by ultrasound system. The visibility of stones was improved by removal of abdominal gas and administration of diuretic agent to dilate the ureter. Cases with urinary tract infection were medicated by antibiotics and the obstruction of the urinary tract was cleared away as soon as possible. RESULTS: Including the cases with residual fragments less than 4 mm, the success rates at one month after the treatment were 97.7% and 98.7% for the renal and ureteral calculi, respectively. The mean numbers of sessions were 1.49 for renal calculi and 1.16 for ureteral calculi. Multiple sessions were required in 24.2% of renal calculi and 12.0% of ureteral calculi. No serious complication has been observed except for three cases, which were sepsis after ESWL, anuria in a solitary kidney, and pyonephrosis caused by Steinstrasse with urinary infection, respectively. CONCLUSION: ESWL using ESL-500A is an efficient treatment of upper urinary tract calculi which has higher pulverization rate and fewer complications in the adequate procedure.     

Extracorporeal shock wave lithotripsy in children

PURPOSE: We analyzed the efficacy of extracorporeal shock wave lithotripsy in children. MATERIALS AND METHODS: Between 1987 and 2000, 15,423 patients with urinary calculi were treated at our institution, of whom 86 (0.56%) children 3 to 14 years old underwent lithotripsy using the Siemens Lithostar Plus (Siemens Medical Systems, Iselin, New Jersey). A total of 121 calculi in 90 urinary tracts were treated requiring 149 extracorporeal shock wave lithotripsy sessions. The stones were caliceal in 62 cases, renal pelvic in 35, ureteral in 18 and staghorn in 6. Followup consisted of nephrotomogram or ultrasound 1 day and 1 to 3 months postoperatively. RESULTS: Complete removal of all stone fragments was achieved in 97.6% of the stones after 3 months. Re-treatment was necessary in 24 patients (27.9%). All patients were treated as outpatients with intravenous sedation in 54 (62.8%), general anesthesia in 13 (15.1%) and no anesthesia in 19 (22.1%). Complications were present in 8 patients (10.7%) who had colic and received medical treatment followed by uneventful recovery. CONCLUSIONS: Extracorporeal shock wave lithotripsy using the Lithostar Plus has been demonstrated to be an effective noninvasive procedure to treat radiopaque and even radiolucent or slightly opaque urinary calculi in children.     

Urinary tract infection in children associated with idiopathic hypercalciuria.

OBJECTIVE: The aim of this study was to evaluate the association of symptomatic non-calculous idiopathic hypercalciuria (IH) with urinary tract infection (UTI) in children. MATERIAL AND METHODS: This was a retrospective case review of children who had urinary calcium excretion greater than 2 mg/kg/day or random urine calcium-creatinine ratio (UCa/UCr) greater than 0.18 mg/mg. RESULTS: One hundred and twenty-four consecutive children with clinical complaints and elevated urine calcium excretion were reviewed. Fifty children (40%) had UTI of which 39 (78%) had recurrent UTI. There was no difference in age between children with UTI and those without UTI. Twenty-four-hour urine calcium and random UCa/UCr were also not different. Only 4 children (8%) had renal stones whereas hematuria, abdominal pain and urine incontinence were frequent associated findings. Six of the children with recurrent UTI (15%) had an anatomical urinary tract abnormality. Therapy in all children consisted of increased fluid intake and reduction in diet sodium and oxalate; however, 14 of the 39 children with recurrent UTI (36%) required therapy with a thiazide diuretic. Recurrent UTI was abolished in 24 children, one child had a single recurrence and 4 children had no response to treatment. CONCLUSIONS: We propose that non-calculous IH may be an important contributing factor to recurrent UTI in children.