Article

Minimally Invasive Surgical Approaches to Kidney Stones in Children

Department of Urology, Uludag University, Faculty of Medicine, 16059, Bursa, Turkey.
Current Urology Reports (Impact Factor: 1.51). 06/2012; 13(4):298-306. DOI: 10.1007/s11934-012-0259-8
Source: PubMed

ABSTRACT

The existing treatment options for pediatric urolithiasis are endoscopic methods. Extracorporeal shockwave lithotripsy (SWL) is the first-line option for most of the kidney stones smaller than 1 cm in diameter. For larger stones or refractory cases, minimally invasive surgical methods are preferred. Percutaneous nephrolithotomy (PCNL) is a well-established treatment modality for most patients. This technique has shown evolution also in children so that miniaturized or tubeless methods could now be performed. Recent series show that flexible ureteroscopy is also becoming an important treatment option in the pediatric urology armamentarium for treating the calyceal and lower pole stones. Open surgery has a very limited role and it may be of use when there is a need to do an adjuvant reconstructive surgery. With the increasing experience, laparoscopic surgery is becoming an alternative option that may have potential to replace the open techniques.

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    ABSTRACT: Traditionally the mainstay of stone treatment in child has been shock wave lithotripsy but pediatric management of urolithiasis has continued to evolve with advances in both technology and skills. This chapter discusses the increasing utility of ureteroscopy in children as well as the feasibility and efficacy of percutaneous nephrolithotomy. Additionally, indications, outcomes, and limitations for both types of management are explored. A step-by-step approach to performing both ureteroscopy and percutaneous nephrolithotomy is outlined along with the appropriate equipment needed for each type of management. Overall, ureteroscopy and percutaneous nephrolithotomy are important treatment modalities in the management armamentarium of the pediatric urologist.
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