Minimally invasive treatment of urinary tract calculi in children

Objective To report experience of a broad multimodality approach to the tre atment of calculi in children using extracorporeal shock wave lithotripsy ( ESWL), ureteroscopy/laser lithotripsy, lithoclast and percutaneous nephroli thotomy (PCNL). Patients and methods The treatment and outcome were reviewed in 43 children managed by a range of minimally invasive modalities, either singly or in c ombination, between 1990 and 1997. These patients represent a selected grou p deemed suitable for minimally invasive management during a period of deve loping experience with these techniques. Of this cohort, six children had p reviously undergone open stone surgery and contributory metabolic abnormali ties were identified in seven. ESWL was the sole treatment modality in 24 c hildren (56%), In five children (12%) ureteroscopy/laser lithotripsy was co mbined with ESWL, eight (18%) underwent ureteroscopy/laser lithotripsy alon e, whilst three with bladder stones were treated with the lithoclast. Combi ned therapy including PCNL was required in three patients. Results Of the 43 children treated, 38 (88%) were rendered stone-free. Meta bolic disorders accounted for three of the five cases of residual calculi, Complications requiring intervention occurred in two children (7%) and thre e subsequently underwent open pyelolithotomy or ureterolithotomy after unsu ccessful minimally invasive treatment. Conclusions Used selectively, the range of minimally invasive procedures av ailable for adults, including ureteroscopy and PCNL, can be safely and effe ctively extended to the treatment of urinary tract calculi in children. The role of open surgery will diminish further with the availability of specia lized instruments for paediatric PCNL.