Paediatric urolithiasis: Medical & surgical management & sophistication

Abstract

Success and safety of endoscopic ureterolithotripsy (EUL) in pediatric patients has been studied by Khudaybergenov et al in a recent retrospective study. The findings support EUL as a first-line treatment, with careful planning needed for younger children. Urolithiasis is a well-known condition. It can affect any part of the urinary tract. It is quite rare in children (1%-7% of all urinary stones occur during childhood). However, its increasing incidence over last several decades is a cause of concern. Childhood urinary lithiasis is related to genetic, climatic, dietary, and socioeconomic factors. Advancing holistic approach is hope for health for all. Evaluation for aetiopathogenesis to expert management, and energetic prevention requires excellence conceptually. Conceptual frameworks present perspectives about a problem systematically and simplify understanding usefully about how complex things work. We discuss advancements as ‘5Ds’ framework: (1) Diligent assessment: Clinically comprehensive. Investigation should be correct and comprehensive with attention to radiation risks. Results guide rationale methodical management; (2) Dedicated management: Correct intervention guided by best evidence; (3) Devoted monitoring: Immediate and long term; (4) Distinctive prevention: With attention to aetiologies; and (5) Developing professionalism: Expertise development with simulation. Special centres/clinics expertise can guide further refinements. In conclusion, early energetic management ensures cure lifelong.

Keywords: Dysuria; Hematuria; Lithotripsy; Laser; Nephrolithotomy; Percutaneous; Renal colic; Robotics; Ureteral calculi; Tomography

Core Tip: Urolithiasis is distressing, demanding energetic management. Acute management requires analgesics and antiemetics as needed. Assessment should be for size, location, and aetiology. Stone passage may be spontaneous and medical expulsive therapy can be tried (small ureteral calculi < 4-5 mm). Stone removal becomes necessary for stones that do not pass or are unlikely to pass spontaneously, and if there is evidence of urinary tract infection. Three definitive interventions available are: Shockwave lithotripsy, ureteroscopy, or percutaneous nephrolithotomy. The underlying metabolic disorder should be addressed. Primary prevention should be for all, and includes physiological functioning.