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Zeng G, Zhu W, Somani B, Choong S, Straub M, Maroccolo MV, Kamal W, Ibrahim TAA, Cho A, Mazzon G, Chai CA, Ferretti S, Zhong W, Onal B, Mohamed O, Saulat S, Jurkiewicz B, Sezer A, Liu Y, Zeng T, Wang W, Gauhar V, Elderwy AA, Zaidi Z, Duvdevani M, Hamri SB, Kumar N, Kartalas-Goumas L, Gadzhiev N, Kraft K, Sepulveda F, Halinski A, Marietti S, Al-Anazi NAS, Santos LS, Vaddi CM, Jia J, Li J, Kuang X, Ye Z, Sarica K. International Alliance of Urolithiasis (IAU) guidelines on the management of pediatric urolithiasis. Urolithiasis 2024; 52:124. [PMID: 39230669 DOI: 10.1007/s00240-024-01621-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2024] [Accepted: 08/17/2024] [Indexed: 09/05/2024]
Abstract
The aim of this study was to construct the sixth in a series of guidelines on the treatment of urolithiasis by the International Alliance of Urolithiasis (IAU) that by providing a clinical framework for the management of pediatric patients with urolithiasis based on the best available published literature. All recommendations were summarized following a systematic review and assessment of literature in the PubMed database from January 1952 to December 2023. Each generated recommendation was graded using a modified GRADE methodology. Recommendations are agreed upon by Panel Members following review and discussion of the evidence. Guideline recommendations were developed that addressed the following topics: etiology, risk factors, clinical presentation and symptoms, diagnosis, conservative management, surgical interventions, prevention, and follow-up. Similarities in the treatment of primary stone episodes between children and adults, incorporating conservative management and advancements in technology for less invasive stone removal, are evident. Additionally, preventive strategies aiming to reduce recurrence rates, such as ensuring sufficient fluid intake, establishing well-planned dietary adjustments, and selective use pharmacologic therapies will also result in highly successful outcomes in pediatric stone patients. Depending on the severity of metabolic disorders and also anatomical abnormalities, a careful and close follow-up program should inevitably be planned in each pediatric patient to limit the risk of future recurrence rates.
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Affiliation(s)
- Guohua Zeng
- Department of Urology and Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.
| | - Wei Zhu
- Department of Urology and Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Bhaskar Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
| | - Simon Choong
- Institute of Urology, University College Hospitals of London, London, UK
| | - Michael Straub
- Department of Urology, Technical University Munich, Munich, Germany
| | | | - Wissam Kamal
- Department of Urology, King Fahd Hospital, Jeddah, Saudi Arabia
| | | | - Alexander Cho
- Great Ormond Street Hospital National Health Service Foundation Trust, London, UK
| | - Giorgio Mazzon
- Institute of Urology, University College Hospitals of London, London, UK
| | - Chu Ann Chai
- Department of Surgery Urology Unit, University Malaya, Kuala Lumpur, Malaysia
| | - Stefania Ferretti
- Department of Urology, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
| | - Wen Zhong
- Department of Urology and Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Bulent Onal
- Department of Urology, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Omar Mohamed
- Department of Urology, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Sherjeel Saulat
- Department of Urology, Tabba Kidney Institute, Karachi, Pakistan
| | - Beata Jurkiewicz
- Paediatric Surgery Department, Warsaw Hospital for Children, Warsaw, Poland
| | - Ali Sezer
- Pediatric Urology Clinic, Konya City Hospital, Konya, Turkey
| | - Yang Liu
- Department of Urology and Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Tao Zeng
- Department of Urology and Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Wei Wang
- Department of Urology, Shanghai Public Health Clinical Center, Center of GRADE, Fudan University, Shanghai, China
| | - Vineet Gauhar
- Department of Urology, Ng Teng Fong General Hospital, The National University Health System, Singapore, 609606, Singapore
| | - Ahmad Abdelaziz Elderwy
- Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Asyut, Egypt
| | - Zafar Zaidi
- The Indus Hospital and Health Network, Karachi, Pakistan
| | | | - Saeed Bin Hamri
- Division of Urology, Department of Surgery, Ministry of the National Guard Health Affairs, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Nitesh Kumar
- Ford Hospital and Research Centre, Patna, 800027, India
| | | | - Nariman Gadzhiev
- Saint Petersburg State University Hospital, St. Petersburg, Russian Federation
| | - Kate Kraft
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Fabio Sepulveda
- Department of Urology, Federal University of Bahia, State Women's Hospital of Bahia, Salvador, Bahia, Brazil
| | - Adam Halinski
- Department of Paediatric Urology, PMC "Wisniowa Clinic", Zielona Gora, Poland
| | - Sarah Marietti
- University of California - San Diego, 200 West Arbor Drive MC 7897, San Diego, CA, 92103, USA
| | | | - Luiz Sergio Santos
- Department of Urology, Federal University of Parana, Curitiba, Paraná, Brazil
| | - Chandra Mohan Vaddi
- Preeti Urology and Kidney Hospital, 307, Remedy Hospital Lane, Mig1, Kphb Colony, Kukatpally, Hyderabad, Telangana, 500072, India
| | - Jianye Jia
- Department of Urology, Peking University International Hospital, Beijing, China
| | - Jun Li
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xiaogen Kuang
- Department of Urology, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Zhangqun Ye
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kemal Sarica
- Department of Urology, Prof. Dr. Ilhan Varank Research and Training Hospital, Istanbul, Turkey.
- Department of Urology, Medical School, Biruni University, Istanbul, Turkey.
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Adanur S, Demirdogen SO, Aksakalli T, Cinislioglu AE, Utlu A, Al S, Akkas F, Altay MS, Polat O. Outcomes of ultraminipercutaneous nephrolithotomy in infants: our experiences at a single center in an endemic region. Pediatr Surg Int 2024; 40:48. [PMID: 38300307 DOI: 10.1007/s00383-023-05623-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/26/2023] [Indexed: 02/02/2024]
Abstract
OBJECTIVE In this study, we aimed to contribute to the literature by sharing the perioperative and postoperative outcomes of infants (0-24 months) who underwent ultra-mini percutaneous nephrolithotomy (PNL) for kidney stones in our clinic. METHODS Infants under 24 months old with kidney stones of 2 cm and larger, who applied to our clinic between January 2018 and May 2023, were included in the study. The patients' demographic and clinical characteristics were obtained from the medical records. The collected data were analyzed retrospectively. RESULTS A total of 26 patients were included in the study. The mean age of the patients was 17.3 ± 3.90 (12-24) months. The mean operation time was 50.7 ± 6.43 min. The mean stone size was 2.66 ± 0.59 cm. Stone-free was achieved in 23 patients (88.5%). In one patient (3.8%) with residual fragments, SWL was performed, and in two patients (7.7%), RIRS was performed to achieve stone-free. Postoperatively, fever was observed in 3 patients (11.5%). There were no patients requiring blood transfusion. CONCLUSIONS In experienced centers, ultra-mini-PNL performed by experienced surgeons is an effective and reliable treatment option for infants under 24 months of age with kidney stones larger than 2 cm. It provides high-stone clearance rates and low complication rates.
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Affiliation(s)
| | | | - Tugay Aksakalli
- Erzurum Regional Training and Research Hospital, Erzurum, Turkey
| | | | - Adem Utlu
- Erzurum Regional Training and Research Hospital, Erzurum, Turkey
| | - Salih Al
- Atatürk University, Erzurum, Turkey
| | - Fatih Akkas
- Erzurum Regional Training and Research Hospital, Erzurum, Turkey
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Durmus E, Ok F. Comparative analysis of ureteroscopic laser lithotripsy and extracorporeal shock wave lithotripsy in the treatment of childhood proximal ureteral stones. Pediatr Surg Int 2022; 39:62. [PMID: 36565334 DOI: 10.1007/s00383-022-05349-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/15/2022] [Indexed: 12/25/2022]
Abstract
PURPOSE This study aims to make a comparative analysis of the superiority of ESWL and URS in proximal ureteral stones in children. METHODS A total of 155 patients under the age of 15 were included in the study. The patients were divided into two groups as Group 1 (n = 80, ESWL) and Group 2 (n = 75, URS) according to the type of procedure performed. The patients in both groups were evaluated in terms of age, gender, lateralization, stone size, stone volüme, stone density, and preoperative hydronephrosis. In addition, both methods used were compared in terms of success rate, time, cost, hospitalization and complications. RESULTS The mean age were 7.4 ± 2.1 in Group-1 and 8.1 ± 1.8 in Group-2. Demographic, clinical and laboratory data of both groups were similar. The hospitalization time, procedure time, success rate and cost were significantly higher in Group-2. The complication rate was significantly higher in Group-2 (p < 0.001). There was a significant negative correlation between ESWL success and stone volume (ρ - 0.375, p = 0.001) and stone density (ρ - 0.283, p = 0.011). CONCLUSION ESWL can be performed as the first line treatment of proximal ureteral stones in children due to its daily use, low cost, short procedure time and low complication rate. Increasing stone volume and density reduces the success of ESWL.
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Affiliation(s)
- Emrullah Durmus
- Department of Urology, Siirt Training and Research Hospital, 56100, Siirt, Turkey.
| | - Fesih Ok
- Department of Urology, Siirt Training and Research Hospital, 56100, Siirt, Turkey
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Ahmad T, Minallah N, Khaliq N, Rashid H, Syed M, Almuradi MAA. Safety and efficacy of minimally invasive percutaneous nephrolithotomy for infantile nephrolithiasis. Single centre experience from Pakistan. Front Pediatr 2022; 10:1035964. [PMID: 36726997 PMCID: PMC9885957 DOI: 10.3389/fped.2022.1035964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 12/28/2022] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE To assess the efficacy and safety of mini-percutaneous nephrolithotomy (PCNL) for small renal stones 1-2 cm in size in infants less than one year. MATERIAL AND METHODS This descriptive case series was conducted in the department of pediatric urology Institute of Kidney Diseases Peshawar, Pakistan, from March 2019 to March 2022. All the patients underwent mini-PCNL in prone position under GA with 14 Fr access sheath and 10 Fr nephroscope. Stone clearance was assessed by non-contrast CT KUB at 30th postoperative day. Patients with no residual fragments on the non-contrast CT KUB were defined as stone-free. Patients with residual fragments of any size were defined as procedure failure. Safety was determined in terms of intra and postoperative complications. RESULTS A total of 51 infants were included in the study. The mean age of patients was 9.6 + 1.8 (5-12 month). The mean stone size was 15.8 + 2.7 (10-21) mm in length and 12.3 + 2.2 (8-17) mm in width. PCNL mean operative time was 51.6 ± 7.1 (40-70) minutes. Complete stone clearance at one month was observed in 46 (90.2%) patients. Residual fragments were seen in 5(9.8%) patients with a mean size of 1.6 + 0.4 (0.9-2.0) mm. None of the patients required any additional procedure for clearance of stones. In 7 (13.7%) patients, some post-operative complications were observe, all were grade I complications, including fever in 5(9.8%) and transient hematuria in 2(3.9%) patients. CONCLUSION Mini-PCNL is a safe and effective treatment for renal stones in infants measuring 1-2 cm with high SFR and an acceptable complication rate.
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Affiliation(s)
- Tariq Ahmad
- Department of Pediatric Urology, Institute of Kidney Diseases, Khyber Medical University, Peshawar, Pakistan
| | - Nasrum Minallah
- Department of Urology, Institute of Kidney Diseases, Khyber Medical University, Peshawar, Pakistan
| | - Nida Khaliq
- Department of Community Medicine, Fazaia Medical Air University, Islamabad, Pakistan
| | - Hania Rashid
- Department of Biochemistry, Fazaia Medical Air University, Islamabad, Pakistan
| | - Misbah Syed
- Department of Urology, Khyber Teaching Hospital, Khyber Medical University, Peshawar, Pakistan
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Vinit N, Khoury A, Lopez P, Heidet L, Botto N, Traxer O, Boyer O, Blanc T, Lottmann HB. Extracorporeal Shockwave Lithotripsy for Cystine Stones in Children: An Observational, Retrospective, Single-Center Analysis. Front Pediatr 2021; 9:763317. [PMID: 34869121 PMCID: PMC8636798 DOI: 10.3389/fped.2021.763317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 10/15/2021] [Indexed: 11/18/2022] Open
Abstract
Purpose: Cystinuria is a genetic disorder characterized by a defective reabsorption of cystine and dibasic amino acids leading to development of urinary tract calculi from childhood onward. Cystine lithiasis is known to be resistant to fragmentation. The aim was to evaluate our long-term experience with extracorporeal shockwave lithotripsy (ESWL) used as first-line urological treatment to treat cystine stones in children. Methods: We retrospectively reviewed the charts of all children who underwent ESWL for cystine stone. We assessed the 3-month stone-free rate, according to age, younger (group 1) or older (group 2) than 2 years old. Results: Between 2003 and 2016, 15 patients with a median (IQR) age at first treatment of 48 (15-108) months underwent ESWL in monotherapy. Median age was, respectively, 15 and 108 months in each group. The median (IQR) stone burden was 2,620 (1,202-8,265) mm3 in group I and 4,588 (2,039-5,427) mm3 in group II (p = 0.96). Eleven patients had bilateral calculi. ESWL was repeated on average 2.4 times, with a maximum of 4 for patients of group I, and 4.8 times, with a maximum of 9 for group II (p > 0.05). ESWL in monotherapy was significantly more efficient to reach stone-free status for children under 2 years of age: 83% vs. 6.2% (p = 0.040). The median (IQR) follow-up of the study was 69 (42-111) months. Conclusion: ESWL appears as a valid urological option for the treatment of cystine stones, in young children. Even if cystine stones are known to be resistant to fragmentation, we report 83% of stone-free status at 3 months with ESWL used in monotherapy in children under 2 years old with cystinuria. In older children, the success rate is too low to recommend ESWL as a first line approach.
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Affiliation(s)
- Nicolas Vinit
- Department of Pediatric Surgery and Urology, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - Antoine Khoury
- Department of Pediatric Surgery and Urology, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - Pauline Lopez
- Department of Pediatric Surgery and Urology, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - Laurence Heidet
- Department of Pediatric Nephrology, Reference Center for Inherited Renal Disease (MARHEA), Necker-Enfants Malades Hospital, APHP, Paris, France.,INSERM UMR 1163, Laboratory of Inherited Kidney Diseases, Imagine Institute, Université de Paris, Paris, France
| | - Nathalie Botto
- Department of Pediatric Surgery and Urology, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - Olivier Traxer
- Department of Urology, Tenon Hospital, APHP, Paris, France.,Groupe de Recherche Clinique sur la Lithiase Urinaire (GRC no 20), Tenon Hospital, Sorbonne Université, Paris, France.,Sorbonne Université, Paris, France
| | - Olivia Boyer
- Department of Pediatric Nephrology, Reference Center for Inherited Renal Disease (MARHEA), Necker-Enfants Malades Hospital, APHP, Paris, France.,INSERM UMR 1163, Laboratory of Inherited Kidney Diseases, Imagine Institute, Université de Paris, Paris, France.,Université de Paris, Paris, France
| | - Thomas Blanc
- Department of Pediatric Surgery and Urology, Necker-Enfants Malades Hospital, APHP, Paris, France.,Université de Paris, Paris, France.,INSERM U1151-CNRS UMR 8253, Université de Paris, Paris, France
| | - Henri B Lottmann
- Department of Pediatric Surgery and Urology, Necker-Enfants Malades Hospital, APHP, Paris, France
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