Pediatric urolithiasis: experience from a tertiary referral center.
OBJECTIVE
Pediatric urolithiasis can cause significant morbidity and damage to the kidney, or even renal failure. We review our experience of the management of urolithiasis in pediatric patients at a tertiary referral center.


METHODS
We reviewed medical records of all children with urolithiasis who were diagnosed and managed at our center from August 2003 to October 2011. Management was planned according to stone burden and location. We noted and statistically analysed data about age, sex, stone burden, clinical features, management, metabolic abnormalities and recurrence.


RESULTS
There were 325 children with 378 stone sites. Age range was 3-17 (mean 8) years. The male to female ratio was 3:1. Most common presentation was abdominal pain in 257 children (79%), and the most common stone site was kidney in 215 (57%). Twenty-four (7%) children (stone burden ≤3 mm) were managed conservatively, while the rest received some form of intervention. Metabolic workup could be done in 154 (47%) children. A metabolic abnormality was seen in 67 (43%) children, normocalcemic hypercalciuria being the most common. Recurrence of urolithiasis was seen in 78 (24%) children after a mean follow-up of 3.2 (1-6) years, and was more common in those who had a metabolic abnormality or in whom small residual fragments were left in situ.


CONCLUSIONS
Availability of smaller instruments has led to safer use of percutaneous endoscopy and ureteroscopy in children, with results comparable to those in adults and an acceptable complication rate. The presence of a metabolic abnormality is quite common and is a cause of recurrence.
Department of Urology and Renal transplantation, Sanjay Gandhi Postgraduate Institute of Medical Science, Raebreali Road, Lucknow 226014, U.P, India.
Abhishek
Jatinder
J
Kumar
Anil
A
Mandhani
Aneesh
A
Srivastava
Rakesh
R
Kapoor
M S
MS
Ansari
D015746:Abdominal Pain / Q000453:epidemiology; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006417:Hematuria / Q000453:epidemiology; D006801:Humans; D008096:Lithotripsy; D008297:Male; D008659:Metabolic Diseases / Q000453:epidemiology; D009017:Morbidity; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D062606:Tertiary Care Centers; D018666:Ureteroscopy; D014552:Urinary Tract Infections / Q000453:epidemiology; D052878:Urolithiasis / Q000453:epidemiology / Q000601:surgery* / Q000628:therapy*
Children; Pediatric; Urinary stones; Urolithiasis