Management of Pediatric Stone Disease: Endourologic Techniques

Document Type

Journal Article

Publication Date

1-5-2012

Journal

Smith's Textbook of Endourology: 3rd Edition

Volume

1

DOI

10.1002/9781444345148.ch65

Keywords

Children; Endourology; Nephrolithiasis; Percutaneous nephrolithotomy; Shock-wave lithotripsy; Ureteroscopy

Abstract

With miniaturization of instruments and refinement of surgical technique, the management of pediatric stone disease has undergone a dramatic evolution. While shock-wave lithotripsy (SWL) is still commonly utilized to treat upper tract calculi, use of ureteroscopy (URS) has dramatically increased and is now the procedure of choice for upper tract stone burdens of less than 1.5 cm at centers with significant experience. Percutaneous nephrolithotomy (PCNL) has replaced open surgical techniques for the treatment of large stone burdens of greater than 2 cm with efficacy and complication rates similar to those in the adult population. Large institutional series demonstrate comparable stone-free and complication rates with SWL, URS, and PCNL, but concerns remain with these techniques regarding renal development and damage to the pediatric urinary tract. Randomized controlled trials comparing the efficacy of SWL and URS for upper tract stone burdens are needed to reach consensus regarding the most effective primary treatment modality in children. © 2012 Blackwell Publishing Ltd.

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