Endourological management of pediatric urolithiasis in Northeast India

Abstract

Background: Urolithiasis affects between 5-10% of the population during their lifetime, 2-3% of them are children. In the last decade, technological advancement and miniaturization of instruments has changed the management of pediatric urinary-stone disease. Extracorporeal shockwave lithotripsy (ESWL) has been preferred method of management of pediatric stone disease, whereas the endoscopic approach is limited to a few centers. Methods: This retrospective study was conducted among the pediatric patients (6-15 years) presenting with urolithiasis during 1 January 2017 to 31 December 2019 to the department of urology, Dispur hospital Pvt. Ltd., Assam. Only confirmed cases of pediatric urolithiasis were included in this study. Medical records were reviewed for clinical and laboratory data including gender, age at diagnosis, clinical presentation, presence of urinary tract anomalies, and urinary tract infections (UTI) in the form of urinalysis, urine culture and complete blood count. Metabolic evaluation was advised in all children. Finally, a total of 100 pediatric urolithiasis cases were included in this study. Results: ESWL was performed in 28 children. The stone-free rate was 85.7%. The total number of shocks per treatment ranged from 1000 to 2000. A total of 10 percutaneous nephrolithotomy (PCNLs) were done with complete stone clearance in 83.33%. In the URS group, urethroscopy was successful in 20 cases (75%). Cystolithotripsy was done in 08 cases with 100% clearance rate. 30 patients were managed conservatively. Conclusions: ESWL is highly effective in children for small stone burden. Early metabolic evaluation and treatment may prevent further renal damage and recurrence.