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Background: Pediatric urolithiasis results in significant morbidity in later life. Incidence as well as site and chemical composition of calculi varies according to the changes in socio-economic conditions over time and the subsequent changes in dietary habits leading to a marked variation in the spectrum of urinary stone composition. To evaluate the spectrum of urinary stone composition in pediatric population from North-western India.Methods: This was a prospective observational study conducted between October 2013 and February 2019 which included pediatric patients with urolithiasis. Demographic and epidemiological characteristics including age, sex, geography, religion, socio-economic status, dietary habits were recorded. The location and sizes of stones were documented. The data was collected, analyzed and presented using summary statistics.Results: A total of 163 patients with urolithiasis were enrolled, of which 86 (53%) aged between 6 and 10 years, 49 (30%) aged between 11 and 14 years and 28 (17%) were aged between 0 and 5 years. The majority of patients were male (n=134; 82.21%). The most common location of the stone was urinary bladder (n=106; 65.03%) followed by kidney (n=33; 20.25%), urethra (n=16; 9.82%) and ureter (n=8; 4.91%). The upper tract (kidney and ureter) to the lower tract (bladder and urethra) stone ratio was 1:4. Stones with mixed composition were more than pure stones (73.62% versus 26.38%). The most common composition was the mixed stone of calcium oxalate, calcium phosphate and uric acid (n=36; 22.09%) followed by mixed stone of calcium oxalate monohydrate and dihydrate with uric acid (n=29; 17.79%), calcium oxalate and uric acid (n=25, 15.34%), calcium oxalate and calcium phosphate (n=20; 12.27%). Calcium oxalate was present in 80% of the stones, followed by uric acid in 7%, struvite in 6%, cystine in 3% and calcium phosphate in 2%.Conclusions: These results suggest that the prevalence of mixed stones with calcium oxalate as the predominant chemical component in the urinary stones of pediatric patients studied.
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Objective: To evaluate the development, safety and efficacy of percutaneous nephrolithotomy(PNL) for management of upper urinary tract calculi in pediatric patients.Methods: In the study, 77 pediatric patients undergoing 87 PNLs through mini or standard tract for upper urinary tract calculi between January 2005 and December 2016 in Peking University People''s hospital were reviewed, including 69 renal calculi, 6 upper ureteral calculi, 12 renal and upper ureteral calculi, 35 single calculi, 43 multiple calculi and 9 staghorn calculi.The development and efficacy of PNL in pediatric patients were studied by analyzing the characteristics and clinical indexes, and by reviewing the associated literature.The Clavien classification system was used to evaluate the complications after PNL.Results: A total of 87 PNLs were performed in 77 pediatric patients.Eighty-one upper urinary tract calculi were managed through a single tract(93.1%), 5 pediatric patients were managed through 2 tracts(5.7%), and 1 pe-diatric patient was managed through 3 tracts(1.2%).The mean operating time was (77.0±29.8) min.The stone-free rate after one session was 100% for single calculi and 71.2% for multiple or staghorn calculi, 5(5.8%) children underwent auxiliary procedure to remove the residual calculi and the final stone-free rate of PNL was 88.5%.One of the main complications of pediatric PNL was fever.Sixteen(18.4%) had moderate fever(38-39 ℃), 5(5.7%) had high fever(39-40 ℃) and there were no severe complications of infection, such as sepsis or septic shock.The mean hemoglobin loss was (10.3±16.1) g/L and the serum creatinine rise was (7.0±13.3) μmol/L.One(1.2%) pediatric patient suffered ureteroscopic lithotripsy because of the obstruction by the residual stone in ureter.No injury of organs or retroperitoneal urinary extravasation occurred.General assessment of the complications showed Clavien grade Ⅰ complications in 14 (16.1%) pediatric patients, grade Ⅱ in 7(8.0%) children and grade Ⅲ in 1(1.2%) children.There was no grade Ⅳ or Ⅴ complications.The overall complication rate was 25.3%.Conclusion: PNL for management of upper urinary tract calculi in pediatric patients is effective.Complications after PNL, as assessed with Clavien classification system, are mild and PNL in pediatric patients is safe.
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Abstract: Background: The prevalence of pediatric urolithiasis varies from 0.01-0.03%. Urolithiasis may be caused by anatomical, metabolic and environmental factors. Recurrence varies between 16 to 67%, and it is frequently associated with metabolic abnormalities. The objective of the present work was the identification of risk factors that promote urolithiasis in a child population. Methods: This study included 162 children with urolithiasis and normal renal function (mean age 7.5 years). Risk factors were investigated in two stages. In the first stage, 24-hour urine, and blood samples were analyzed to assess metabolic parameters and urinary tract infection. During the second stage, the effect of calcium restriction and a calcium load on renal Ca excretion were evaluated. Data were statistically analyzed. Results: Urolithiasis was observed in 0.02% of children, 50% of them with family history of urinary stones. There were multiple risk factors for urolithiasis including hypocitraturia (70%), hypomagnesuria (42%), hypercalciuria (37%; in 11/102 was by intestinal hyperabsorption, in 13/102 was unclassified. Ca resorption or renal Ca leak were not detected). We also detected alkaline urine (21%), systemic metabolic acidosis (20%), urinary infections (16%), nephrocalcinosis with urolithiasis (11%), oliguria (8%), urinary tract anomalies, hyperuricosemia and hypermagnesemia (7% each one), hypercalcemia (6%), hyperoxaluria (2%) and hypercystinuria (0.61%). Conclusions: Hypocitraturia and hypomagnesuria were the most frequent risk factors associated with urolithiasis, followed by hypercalciuria. High PTH values were excluded. Children presented two or more risk factors for urolithiasis.
Resumen: Introducción: La prevalencia de urolitiasis pediátrica varía de 0.01-0.03%. Las causas de urolitiasis pueden ser anatómicas, metabólicas o ambientales. Las recurrencias varían entre 16 a 67%, y están frecuentemente asociadas con alteraciones metabólicas. El objetivo del presente trabajo fue la identificación de factores de riesgo que promueven la urolitiasis en una población infantil. Métodos: Se incluyeron 162 niños con urolitiasis y función renal normal, cuya edad media fue de 7.5 años. Los factores de riesgo fueron investigados en dos etapas. En la primera, con la muestras de orina de 24 h y sangre, se investigaron parámetros metabólicos e infecciones del tracto urinario. En una segunda etapa se valoró la calciuria, previa restricción seguida de carga de Ca. Los hallazgos fueron analizados estadísticamente. Resultados: Se presentó urolitiasis en el 0.02% de los niños con historia familiar en el 50%. Se observó hipocitraturia (70%); hipomagnesuria (42%); hipercalciuria (37%; en 11/102 fue por hiperabsorción intestinal; en 13/102 fue inclasificable; no se observó hipercalciuria por resorción o pérdida renal). También se observó orina alcalina (21%); acidosis metabólica sistémica (20%); infecciones urinarias (16%); nefrocalcinosis con urolitiasis (11%); oliguria (8%); anomalías urinarias congénitas, hiperuricosemia e hipermagnesemia (7% cada una); hipercalcemia (6%); hiperoxaluria (2%); e hipercistinuria (0.61%). Conclusiones: La hipocitraturia e hipomagnesemia fueron los factores de riesgo con mayor frecuencia, seguidos de hipercalciuria. Se excluyeron los valores de hiperparatiroidismo. Los niños exhibieron dos o más factores de riesgo para el desarrollo de urolitiasis.
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PURPOSE: To retrospectively evaluate the efficacy of extracorporeal shock wave lithotripsy (ESWL) by age and current condition as a first-line treatment for pediatric and adolescent urolithiasis. MATERIALS AND METHODS: The computerized records of 55 children were retrospectively reviewed from March 1991 to July 2007. The children were below 18 years of age and had undergone ESWL monotherapy for urolithiasis. There were 36 boys (65.5%) and 19 girls (34.5%), with a mean age of 8.5 years (range, 0.5-18 years). There were 24 patients aged 7 years or less and 31 patients aged more than 7 years. RESULTS: The mean size of the stones was 9.48 mm (range, 4-22 mm). The overall success rate of ESWL was 90.9% (50 children). The mean number of ESWL sessions was 2.02 (range, 1-10). The mean number of ESWL sessions for the patient group aged 7 years or less was 1.16 (range, 1-2) and that for the patient group aged more than 7 years was 2.97 (range, 1-10; p=0.037). There was also a statistically significant difference in the mean number of ESWL sessions between the younger and older patients who needed general anesthesia (1.16 vs. 2.2 sessions, respectively; 0.042). CONCLUSIONS: In the patient group aged 7 years or less, the number of ESWL sessions and the complication rate were comparable with those for endoscopic management. Thus, ESWL is an effective first-line treatment modality for patients aged less than 7 years.
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Adolescent , Child , Female , Humans , Anesthesia, General , Lithotripsy , Retrospective Studies , Shock , UrolithiasisABSTRACT
PURPOSE: We investigated the influence of overweight on 24-hour urine chemistry studies and recurrent urolithiasis (UL) in children. MATERIALS AND METHODS: A retrospective cohort study was designed to assess children who presented with UL at a pediatric institution between 1985 and 2010. We calculated body mass index percentile (BMIp) adjusted for gender and age according to the 2007 Korean Children and Adolescents Growth Chart and stratified the children into 3 BMI categories: lower body weight (LBW, BMIp or =85). Twenty-four hour urine chemistry studies (urine volume, creatinine, calcium, oxalate, citrate, and pH) were compared between the 3 BMIp groups. Univariate and multivariate analyses were performed to assess independent risk factors for stone recurrence. RESULTS: A total of 125 patients were included. The age of the patients in the NBW group was older than that of patients in the LBW group, but 24-hour urine chemistry studies did not differ significantly between the three groups. Mean urine citrate levels were lower (0.273+/-0.218 mg/mg/d vs. 0.429+/-0.299 mg/mg/d, p<0.05) and the incidence of hypocitraturia was higher (81.5% vs. 45.7%, p<0.05)) in the recurrent stone former group. In the univariate analysis, hypocitraturia and acidic urinary pH were risk factors, but in the multivariate analysis, only hypocitraturia was a risk factor for stone recurrence (hazard ratio, 3.647; 95% confidence interval, 1.047 to 12.703). In the Kaplan-Meier curve, the hypocitraturia group showed higher recurrence than did the normocitraturia group (p<0.05). CONCLUSIONS: Unlike in adults, in children, overweight adjusted for gender and age was not associated with 24-hour urine chemistry studies and was not a risk factor for recurrent UL. Hypocitraturia was the only risk factor for UL in children.
Subject(s)
Adolescent , Adult , Child , Humans , Body Mass Index , Body Weight , Calcium , Citric Acid , Cohort Studies , Creatinine , Growth Charts , Hydrogen-Ion Concentration , Incidence , Multivariate Analysis , Overweight , Recurrence , Retrospective Studies , Risk Factors , UrolithiasisABSTRACT
A clinical observation was made on 13 cases of pediatric urolithiasis admitted to the Department of Urology. Han Il Hospital during the period from Jan., 1971 to Dec., 1975, and the following results were obtained. 1) Among 78 cases of pediatric in-patient, 13 cases were pediatric urolithiasis, 10 cases were male and 3 cases were female. 2) Age distribution was between 2 and 13 years, showing the highest incidence in 7yrs (23.0%). 3) The etiology of urinary tract stone: 2 cases in congenital anomaly, 8 cases in idiopathic, 1 case in foreign body, 1 case in immobilization, 1 case in recurrent infection. 4) Locational distribution of urinary tract stone was 5 cases in ureter, 4 cases in bladder, 3 cases in urethra, 2 cases in kidney. 5) The largest stone extracted was 2.0cm in size. 6) The common clinical manifestation of upper urinary tract stone included flank pain (71.4). hematuria (57. 1%) and lower urinary tract stone included painful urination (85. 7%), frequent urination (71.4%). 7) The most frequent method of treatment was lithotomy(57%). 8) The results of chemical analysis of 9 urinary calculi showed ca. oxalate in 33.3%, cal. Phosphate + oxalate in 33.3%.