High prevalence of pediatric urinary tract stones in Xinjiang Uyghur.

The aim of the study was to report the characteristics of urolithiasis in Uyghur patients from Xinjiang, China. The composition of stones collected from 1863 patients in the Uyghur region of Xinjiang was analyzed. The median age of patients was 17 years [25th and 75th percentiles: 2, 36]. The stones were delivered by 1299 males (69.7%) and 564 females (30.3%). Calcium oxalate was the predominant stone component in 42.1% of the patients, followed by ammonium urate in 20.6%. Females had formed more stones of magnesium ammonium phosphate 8.9 vs. 5.6% (p = 0.010) and carbonate apatite 6.2 vs. 3.3% (p = 0.004). In contrast uric acid was more common in males than in females; 21.6 vs. 15.1% (p = 0.001). In this series, pediatric patients (age range 0-18) were more likely to present with a stone (51.5%, p < 0.001). Moreover, the largest number of pediatric stones was recorded in children 1-2 years old (37.9%, p < 0.001). The occurrence of ammonium urate stones was extremely high (52.4%) in children with an age below 1 year. There was a downward trend for ammonium urate with age in both children and adults (p for trend < 0.001, respectively). In contrast the frequency of uric acid declined with age in pediatric patients, but increased in adults (p for trend < 0.001, respectively). This study provides a basis for further considerations on the management of Xinjiang Uyghur patients and emphasize the severity of pediatric stone problems.

Composition of urinary tract stones formed by children in two populations in the Uyghur region of China.

BACKGROUND: To retrospectively compare the composition of urinary tract stones formed by Uyghur children from the southern (Kashgar) and northern (Urumchi) parts of the Xinjiang region. METHODS: The chemical composition of urinary tract calculi formed by 855 Uyghur children from the two regions in Xinjiang (366 Kashgar and 489 Urumchi) was compared retrospectively. Stone composition was determined by infrared spectroscopy. Factors that might have been of relevance for the findings such as age, gender, stone location and geographic region were also considered. RESULTS: Kashgar children were younger than Urumchi children (2.8 ± 2.7 vs. 4.3 ± 3.7 years, p < 0.001). Although ammonium urate was the dominant stone component in the whole population, calcium oxalate was most common in children from Urumchi. The mean occurrence of ammonium urate, calcium oxalate and uric acid differed significantly between stones formed by Kashgar and Urumchi children (52.5% vs. 29.2%, 18.9% vs. 29.4%, 12.3% vs. 20.9%; respectively, p < 0.001). Renal stones were less frequently recorded in Kashgar children than in Urumchi children (65.8% vs. 91.6%, p < 0.001). Interestingly, bladder stones were more common in children from Kashgar (28.4% vs. 3.7%; p < 0.001). CONCLUSION: Uyghur children from the southern part of Xinjiang apparently had a more serious form of stone disease than children from the northern part and the occurrence of stones dominated by ammonium urate stones was extremely high in children from the southern part of the region.

Kidney Stone Composition in Third-World Areas: What Kashgar Tells Us?

OBJECTIVE: To analyze urinary stone compositions in patients from Kashgar, China. MATERIALS AND METHODS: We analyzed the components of urinary stones in 732 consecutive patients with urolithiasis admitted to the First and Second People's Hospital of Kashgar Prefecture, Xinjiang, from July 2014 to November 2016. The patients were divided into two groups by ages: group A, 0 to 18 years and group B, >18 years old. The distributions of various stone compositions were analyzed and correlated with the gender and age. RESULTS: The mean age of group A was 3.90 ± 4.09 years and that of group B was 39.88 ± 16.40 years. The overall gender ratio (male:female) was 2.27:1. Ammonium acid urate (AAU) stone was the most frequent stone, male 35.83% and female 33.48%. Female patients were significantly more common than male patients in calcium apatite stone (p = 0.004). Of all 732 cases, patients younger than 18 years were more than patients older than 18 years (58.47% vs 41.53%). The majority of the patients (77.87%) had the stone located in the upper urinary tract. Two peak ages for both genders were noted in 1 to 3 years and 19 to 40 years group of the patients. In group of 1 to 3 years patients, male were more than female (37.60% vs 24.55%, p = 0.001), whereas in the group of 10 to 18 years patients, female were more than male (10.71% vs 4.13%). AAU was the predominant stone component in group <1 year (70. 5%, p < 0.01, as compared with other groups.). Uric acid stone was more prevalent in group >60 years (66.8%, p < 0.01) than in other groups. Patients in 1 to 3 years were in the peak age group of AAU stones in both the upper and lower urinary tract. CONCLUSION: Most of the patients with urolithiasis diagnosed and treated in Kashgar are <18 years old, especially younger than 3 years old. The most frequent stone component in this area was AAU. More than 50% patients <18 years old had AAU stone. The mechanisms that could trigger the high prevalence of AAU stone in patients <18 years old are worth further investigation.

Super-mini PCNL (SMP): Material, indications, technique, advantages and results.

OBJECTIVE: To introduce an emerging technique termed 'super-mini- percutaneous nephrolithotomy' (SMP) and describe its application in practice. METHODS: We described the technique of SMP in the treatment of renal stones with emphasis on the material, indications, technique procedure, advantages, and results. RESULTS: SMP refers to a 7 Ch. nephroscope placed through a 10-14 Ch. metal access sheath with functions of both irrigation and suction-evacuation, to achieve stone fragmentation via laser or pneumatic lithotripsy. We reported our experience of this technique in 342 cases including 231 adults and 111 children. The mean stone size was 2.3 ± 0.9 cm resulted in 54.3 ± 27.7 min of mean operative time in adults, as well as 39.4 ± 26.2 min for stone size of 1.4 ± 0.5cm in children. In parallel, the initial stone-free rate (SFR) was 89.2% and 90.0% followed with a 94.4% and 95.5% of final SFR at 3 months in adults and children, respectively. No transfusions were needed in all patients. Tubeless was achieved in 93.9% and 100%of patients in adults and children respectively. The mean hospital stay was 2.3 ± 0.8 d and 2.7 ± 1.5 d respectively. CONCLUSIONS: SMP are suited for stones less than 2.5 cm in size. It is also suited for special situations such as pediatric moderate-sized stones, previously failed SWL or RIRS approaches. It has advantages of a shorter operative time and hospital stays, with a largely reduction use of drainage catheter after procedure. The indications of the SMP may also compete with those of SWL and RIRS.

Super-mini PCNL (SMP): Material, indications, technique, advantages and results / Supermini NLP (SMP): Material, indicaciones, técnica, ventajas y resultados

OBJECTIVE: To introduce an emerging technique termed 'super-mini- percutaneous nephrolithotomy' (SMP) and describe its application in practice. METHODS: We described the technique of SMP in the treatment of renal stones with emphasis on the material, indications, technique procedure, advantages, and results.RESULTS: SMP refers to a 7 Ch. nephroscope placed through a 10-14 Ch. metal access sheath with functions of both irrigation and suction-evacuation, to achieve stone fragmentation via laser or pneumatic lithotripsy. We reported our experience of this technique in 342 cases including 231 adults and 111 children. The mean stone size was 2.3 ± 0.9 cm resulted in 54.3 ± 27.7 min of mean operative time in adults, as well as 39.4 ± 26.2 min for stone size of 1.4 ± 0.5cm in children. In parallel, the initial stone-free rate (SFR) was 89.2% and 90.0% followed with a 94.4% and 95.5% of final SFR at 3 months in adults and children, respectively. No transfusions were needed in all patients. Tubeless was achieved in 93.9% and 100% of patients in adults and children respectively. The mean hospital stay was 2.3 ± 0.8 d and 2.7 ± 1.5 d respectively. CONCLUSIONS: SMP are suited for stones less than 2.5 cm in size. It is also suited for special situations such as pediatric moderate-sized stones, previously failed SWL or RIRS approaches. It has advantages of a shorter operative time and hospital stays, with a largely reduction use of drainage catheter after procedure. The indications of the SMP may also compete with those of SWL and RIRS

OBJETIVOS: Introducir una técnica emergente llamada super mini nefrolitotomía percutánea (SMP) y describir su aplicación en la práctica clínica. MÉTODOS: Describimos la técnica de SMP en el tratamiento de la lithiasis renal con énfasis en el material, las indicaciones, la operación, las ventajas y los resultados. RESULTADOS: La SMP se refiere al uso de un nefroscopio 7 Ch. alojado en una vaina de acceso metálica del 10-14 Ch. con la doble función de irrigación y aspiración-evacuación para conseguir la fragmentación de la litiasis con láser o litotricia neumática. Comunicamos nuestra experiencia en esta técnica en 342 casos incluyendo 231 adultos y 111 niños. El tamaño medio de la litiasis fue de 2,3 ± 0,9 cm resultado en 54,3 ± 27,7 min de operación en adultos, así cómo 39,4 ± 26,2 min para un tamaño de litiasis de 1,4 ± 0,5 cm en niños. En paralelo, el porcentaje de pacientes libres de litiasis fue del 89,2% y 90,0%, seguido por un 94,4% y 95,5% final a los 3 meses en adultos y niños respectivamente. Ningún paciente necesitó transfusión. El 93,9% y 100% de los pacientes se manejaron sin nefrostomía, adultos y niños respectivamente. La estancia media fue de 2,3 ± 0,8 y 2,7 ± 1,5 días respectivamente. CONCLUSIONES: La SMP es adecuada para piedras de tamaño menor de 2,5 cm. También es adecuada para situaciones especiales como litiasis de tamaño moderado en niños, fallo previo de LEOC o CRIR. Tiene la ventaja de un tiempo operatorio y estancia hospitalaria más cortos, con una reducción considerable del uso de catéter de drenaje después de la operación. Las indicaciones de SMP también pueden competir con las de LEOC o CRIR

Impaction and Prediction: Does Ureteral Wall Thickness Affect the Success of Medical Expulsive Therapy in Pediatric Ureteral Stones?

OBJECTIVE: The study aimed to evaluate the predictive value of ureteral wall thickness (UWT) and stone-related parameters for medical expulsive therapy (MET) success with an alpha blocker in pediatric upper ureteral stones. PATIENTS AND METHODS: A total of 35 children receiving MET ureteral stones (<10 mm) were evaluated. Patients were divided into 2 subgroups where MET was successful in 18 children (51.4%) and unsuccessful in 17 children (48.6%). Prior to management, stone size, stone density (in Hounsfield unit), degree of hydronephrosis, and UWT were evaluated with patient demographics and recorded. The possible predictive value of these parameters in success rates and time to stone expulsion were evaluated in a comparative manner between the 2 groups. RESULTS: The overall mean patient age and stone size values were 5.40 ± 0.51 years and 6.24 ± 0.28 mm, respectively. Regarding the predictive values of these parameters for the success of MET, while stone size and UWT were found to be highly predictive for MET success, patients age, body mass index, stone density, and degree of hydronephrosis had no predictive value on this aspect. CONCLUSIONS: Our findings indicated that some stone and anatomical factors may be used to predict the success of MET in pediatric ureteral stones in an effective manner. With this approach, unnecessary use of these drugs that may cause a delay in removing the stone will be avoided, and the possible adverse effects of obstruction as well as stone-related clinical symptoms could be minimized.

Super-Mini Percutaneous Nephrolithotomy in the Treatment of Pediatric Nephrolithiasis: Evaluation of the Initial Results.

OBJECTIVE: To evaluate the efficacy and safety of super-mini percutaneous nephrolithotomy (SMP) in the treatment of pediatric kidney stones. PATIENTS AND METHODS: We reviewed the records of 111 children with renal stones treated with SMP technique in four different centers between September 2014 and September 2015. The indications for SMP treatment in all these kids were either previously failed shock wave lithotripsy or retrograde intrarenal surgery approaches, according to their parents' preferences. Nephrostomy tracts used in the SMP system ranged from 10F to 14F in size. Lithotripsy was performed using either a Holmium laser or pneumatic lithotripter. Perioperative and postoperative parameters along with operative data were recorded in detail and stone components were analyzed by infrared spectroscopy. RESULTS: This study included 71 boys and 40 girls with a mean age of 3.90 ± 3.53 years (range 0.5-15). The mean stone burden was 1.4 ± 0.6 cm (range 0.8-4.8). Mean operative time was 39.4 ± 26.2 minutes (range 7-105). The mean hemoglobin drop was 10.2 ± 7.1 g/L (range 0-25) and no transfusion was needed. Significant complications were observed in 17 (15.3%) children with 10 and 7 cases in Clavien grade I and grade II, respectively. Complete stone clearance on postoperative day 1 and on 3-month follow-up was 84.7% (94/111) and 90.1% (100/111), respectively. Ninety-five (85.6%) children did not require any type of catheters (total tubeless). The mean hospital stay was 2.7 ± 1.5 days (range 1-7). CONCLUSIONS: Our preliminary data demonstrated that SMP was safe and effective. SMP could be a feasible treatment option for pediatric stone disease. Further randomized controlled trials are still needed to prove the efficacy of using the SMP system in children, particularly in those with larger stones.