RESUMO
Objective:To investigate the characteristics of urinary stones composition in children and the differences in their distribution among different sexes and age groups.Methods:The clinical data of 592 children with urinary stones who underwent stone composition analysis using infrared spectroscopy at Hunan Children's Hospital from October 2015 to October 2019 were retrospectively analyzed. There were 430 males and 162 females.The median age was 4.0 (0.3 to 18.0) years old. The stone composition and the differences in its distribution in different sex and age groups were analyzed.Results:A total of 643 urinary stones were analyzed in 592 cases, with 419 (65.2%) single-component stones and 224 (34.8%) mixed-component stones. The main stone components were calcium oxalate in 361 cases (56.1%), ammonium hydrogen urate in 130 cases (20.0%), cystine in 56 cases (8.7%), calcium phosphate in 33 cases (5.1%), uric acids in 33 cases (5.1%), magnesium ammonium phosphate in 25 cases (3.9%), and xanthine in 5 cases (0.8%). The percentage of calcium oxalate stones was higher in women than in men [65.6% (118/180) vs. 52.5% (243/463), P<0.05]. The proportion of upper urinary tract stones was higher in girl than in boy[93.4%(168/180) vs. 73.2%(339/463), P<0.05]. The differences in the composition ratios of calcium oxalate stones, ammonium hydrogen urate, cystine, and magnesium ammonium phosphate stones in different age groups were statistically significant ( P<0.05), with the highest proportion of calcium oxalate stones (35.6%) at 6 to 10 years of age, ammonium hydrogen urate and cystine stones at 1 to 2 years of age (45.4% and 42.9%), and magnesium ammonium phosphate stones at 3 to 5, 6 to 10, and 11 to 18 years of age, the percentage of urinary stones in children was 24%. Conclusions:The main component of urinary stones in children is calcium oxalate, followed by ammonium hydrogen urate and cystine. Age and gender correlate with the distribution of stone components. Calcium oxalate stones are common in females and in children aged 6 to 10 years, ammonium hydrogen urate and cystine stones are common in children aged 1 to 2 years, and magnesium ammonium phosphate stones are more common in children aged 3 to 5 years, 6 to 10 years, and 11 to 18 years.
RESUMO
Objective To evaluate the safety and efficacy of retrograde intrarenal surgery (RIRS)and minimally invasive percutaneous nephrolithotripsy (MPCNL)for the pediatric renal calculi (≥ 1.5 cm).Methods In the retrospective study,97 patients with renal calculi (≥ 1.5 cm) underwent operation which is conducted by the same operative team from March 2011 to March 2016.Among them,40 patients were treated with RIRS,including 29 male and 11 female patients.57 patients were treated with minimally invasive percutaneous nephrolithotripsy,including 45 males and 12 female patients.The mean stone size was (1.9 ± 0.4) cm (ranging 1.5-3.0 cm) in the RIRS group and (2.1 ± 0.5) cm(ranging 1.5-3.5 cm) in the MPCNL group.In RIRS group,3 stones were stag-horn calculi.The diameter in 44 stones was more than 1.5 cm.Among them,33 stones located in the renal pelvis and upper middle calyces.11 stones located in the lower calyces.Multiple stones were found in 30 cases and single stone was found in 10 cases.7 cases had the history of unilateral urolithiasis.3 cases had the positive results of urine culture before operation.In MPCNL group,7 stones were stag-horn calculi.The diameter in 60 stones was more than 1.5 cm.Among them,56 stones located in the renal pelvis and upper middle calyces.4 stones located in the lower calyces.Multiple stones were found in 41 cases and single stone was found in 16 cases.4 cases had the history of unilateral urolithiasis.2 cases had the positive results of urine culture before operation.The mean stone size in MPCNL was larger,but the difference was not statistically significant (P ＞ 0.05).No statistical significance was found between the two groups in sex,age,preoperative urine,positive culture,patients with renal staghorn calculi,percentage of multiple calculi,stones in lower calyx and operation history of the same side(P ＞ 0.05).The urine white blood cells between the two groups were statistically significant (P ＜0.01),but the urine white blood cells in RIRS before placing double J stent had no significant difference with those in MPCNL.Results In RIRS group,The mean operative time was(90.2 ± 17.8) minutes.The mean hemoglobin deficit was (7.9 ± 7.9)g/L.The complication rate was 7.5％ (3/40).The postoperative hospital stay was (5.0 ± 2.3) days.The hospitalization cost was (42 994.1 ± 9 747.8) yuan.Stone-free rates after one session was 72.5％ (29/40).After second procedure,stone-free rates were up to 90.0％ (36/40).In MPCNL group,the mean operative time was (77.8 ± 15.6) min.The mean hemoglobin deficit was (10.0 ± 7.1) g/L.The complication rate was 24.6％ (14/57).The postoperative hospital stay was (8.0 ±2.5) days.The hospitalization cost was (24 626.3 ± 6 324.7) yuan.The stone-free rate after one session was 82.5％ (47/57).After second procedure,stone-free rates were up to 94.7％ (54/57).In statistics,there was no significant difference in hemoglobin drop,the stone-free rate on one session and the final stone-free rates(P ＞ 0.05).But significant difference existed in operative time,complications rate,postoperative hospitalization time and hospitalization cost (P ＜ 0.05).Conclusion Both RIRS and MPCNL are feasible,safe and minimally invasive way to treat renal calculi(≥ 1.5 cm) in pediatric patients.The stone-free rates between the two groups are comparable.RIRS has an advantage in postoperative hospitalization time and postoperative complications.MPCNL takes the advantage of operation time,hospitalization cost and needn't routinely places the double-J ureteral stent.