FEWER CHILDREN REQUIRE SURGERY FOR KIDNEY STONES

In the past two decades, there has been a dramatic shift in how physicians treat adults with kidney stones. Smaller incisions were shortly followed by smaller ureteroscopes. Thanks to the introduction of extracorporeal shock wave lithotripsy in 1982, most adult patients can avoid surgery. Researchers in Florida reviewed the past ten years to see if technological advances have also changed the way doctors treat children with kidney stones.

Approximately 7 percent of all stones occur in children younger than age 16 years.

In the Journal of Urology, August 1996, researchers examined the treatment of pediatric kidney stone disease at the University of Florida, Gainesville and Nemours Children's Clinic, Jacksonville, Florida.

A total of 100 patients (46 boys and 54 girls) were treated for kidney stones at the two institutions between 1984 and 1994. The children's ages ranged from 2 months to 18 years. Both children and adults develop kidney stones for a variety of reasons.

Medical records reveal that nearly 75 percent of the pediatric patients were at risk for stone formation. High levels of urinary calcium--as well as kidney, bladder, and urinary tract abnormalities--were the most common risk factors identified. Cystic fibrosis, immobility, and sarcoidosis potentially contributed to stone formation in others.

Investigators found that most kidney stones were diagnosed after the children complained of pain. Hematuria (blood in the urine) was evident in 30 cases, and 25 stones were discovered while the child was being monitored for another medical condition. Some children formed more than one stone. Stones were lodged in various regions of the urinary tract--71 in the kidney, 41 in the ureter, 21 in the bladder, and 3 in the urethra. Stone analysis was available in 67 cases.

One of every five children in the study required traditional surgery to remove stones. Seventy-nine children were treated with ESWL, percutaneous procedures, drugs, stents, or close observation; only 25 children required surgical procedures including cystolithotomy, nephrolithotomy, partial nephrectomy, pyelolithotomy, ureterolithotomy, and urethral stone extraction.

In contrast, a study mentioned only open surgical treatment procedures to remove stones in pediatric patients. Researchers concluded that technology has had a positive impact on the treatment of kidney stone disease among children.

Last updated Dec 12/06