The evolution of the endourologic management of pediatric stone disease

In the 1980s, the advent of shock wave lithotripsy (SWL) revolutionized pediatric stone management and is currently the procedure of choice in treating most upper tract calculi < 1.5 cm in children. However, with miniaturization of instruments and refinement of surgical technique the management o...

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Bibliographic Details
Published inIndian journal of urology Vol. 25; no. 3; pp. 302 - 311
Main Authors Smaldone, Marc C, Gayed, Bishoy A, Ost, Michael C
Format Journal Article
LanguageEnglish
Published India Medknow Publications and Media Pvt. Ltd 01.07.2009
Medknow Publications & Media Pvt. Ltd
Medknow Publications
Wolters Kluwer Medknow Publications
Subjects
Care and treatment
Children
Diagnosis
endourology
Health aspects
Kidney stones
Lithotripsy
Medical imaging
nephrolithiasis
Patient outcomes
Pediatrics
percutaneous nephrolithotomy
Percutaneous nephrostomy
Review
shockwave lithotripsy
ureteroscopy
Urogenital system
India
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Summary:In the 1980s, the advent of shock wave lithotripsy (SWL) revolutionized pediatric stone management and is currently the procedure of choice in treating most upper tract calculi < 1.5 cm in children. However, with miniaturization of instruments and refinement of surgical technique the management of pediatric stone disease has undergone a dramatic evolution over the past twenty years. In a growing number of centers, ureteroscopy (URS) is now being performed in cases that previously would have been treated with SWL or percutaneous nephrolithotomy (PCNL). PCNL has replaced open surgical techniques for the treatment of large stone burdens> 2 cm with efficacy and complication rates similar to the adult population. Recent results of retrospective reviews of large single institution series demonstrate stone free and complication rates with URS comparable to PCNL and SWL but concerns remain with these techniques regarding renal development and damage to the pediatric urinary tract. Randomized controlled trials comparing the efficacy of SWL and URS for upper tract stone burden are needed to reach consensus regarding the most effective primary treatment modality in children. This report provides a comprehensive review of the literature evaluating the indications, techniques, complications, and efficacy of endourologic stone management in children.
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ISSN:0970-1591
1998-3824
DOI:10.4103/0970-1591.56177