Endourologic management of pediatric urolithiasis: proposed clinical guidelines.
OBJECTIVE
Pediatric urolithiasis can be managed with various endourologic techniques, which are challenging and demanding. With the availability of advanced minimally invasive techniques, one has to select the appropriate modality. We analyzed the results of various techniques selected prospectively on the basis of our guidelines for the management of pediatric urolithiasis.


METHODS
We analyzed the results of percutaneous nephrolithotomy (PCNL), ureteroscopy (URS), and extracorporeal shockwave lithotripsy (SWL) in 45 children treated at our institute between January 2004 and May 2005. There were 35 boys and 10 girls ranging from 12 months to 17 years age (median age 8.2 +/- 5.72 years), with 25 children (55.6%) under the age of 8 years. Stone-free rate, complications, and hospital stay were assessed.


RESULTS
Extracorporeal lithotripsy was performed in 13 children (15 renal units) with average stone surface area of 50.8 +/- 35.8 mm(2). The stone-free rate was 92.3%. The total number of shocks per treatment ranged from 450 to 1400 (mean 856.3 +/- 189.6). A total of 25 PCNLs were done. Stone extraction was completed in a single stage in 20 units (80%), whereas 5 units (20%) required a second stage. Stone-free status was achieved in 23 renal units (95.8%). In the URS group, 9 procedures were planned in 8 children, and rigid ureteroscopy was successful in 6 (66.7%).


CONCLUSIONS
With the availability of various alternative approaches, proper treatment planning and judicious use of minimally invasive techniques can cure most patients. On the basis of our experience and results, we recommend an algorithm for the management of pediatric stone disease.
Erdenetsesteg
Gotov
G
Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India.
Manohar
T
T
Singh
Harban
H
Desai
Mahesh R
MR
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D017602:Lithotripsy, Laser / Q000379:methods*; D008297:Male; D011183:Postoperative Complications; D017410:Practice Guidelines as Topic; D011860:Radiography, Abdominal; D016896:Treatment Outcome; D018666:Ureteroscopy; D052878:Urolithiasis / Q000000981:diagnostic imaging / Q000628:therapy*