Strategies for managing upper tract calculi in young children

Purpose: Pediatric urolithiasis is relatively uncommon and there is little information on the application of modern surgical procedures in young child ren. We present a single center experience with the surgical management of upper tract calculi in this age group. Materials and Methods: We reviewed presentation, co-morbidity, treatment, o utcome and complications in all prepubertal patients who required surgical treatment for ureteral or renal calculi during a 4-year period. The series consists of 24 girls and 17 boys 17 months to 14 years old (mean age 7.5 ye ars). A total of 26 children were anatomically normal, and 4 had myelomenin gocele, 4 had ureteropelvic junction obstruction (in a pelvic kidney in 1), 2 had cloacal anomalies, 2 had vesicoureteral reflux, and 1 each had nonre fluxing megaureter, orthotopic ureterocele and a functioning renal transpla nt. Results: Extracorporeal shock wave lithotripsy was performed in 24 patients . Stents or nephrostomy tubes were only used in the 4 patients who presente d with pyonephrosis. Of the 41 cases 17 were rendered stone-free, 3 had a d ecreased stone burden and 4 were failures. Ureteroscopic extraction of dist al ureteral calculi was successful in 11 of 12 children, of whom the younge st was 2.5 years old. No child had postoperative infection or evidence of u reteral obstruction. Stent placement facilitated stone passage or dissoluti on in 2 patients, a renal calculus was percutaneously extracted in 2 and 7 required open surgery, mostly for correcting simultaneous anatomical abnorm alities or after minimally invasive surgery failed. Some metabolic abnormal ity was detected in 80% of the children tested. Conclusions: The surgical management of upper urinary tract calculi in youn g children parallels that in adults. Minimally invasive surgical methods ma y be safely used even in young infants. Most children do not need elective stenting before lithotripsy. Open procedures are still required in 17% of c ases. The majority of children have definable metabolic abnormalities.