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a Ultrasound images of non-obstructing renal stone in renal pelvis of a 13-year-old girl. Note the acoustic shadowing behind the stone in first panel and the Doppler signal on the stone in the second panel creating the “twinkling artifact.” b Intra-operative image showing ureteroscope (white arrow) in lower pole calyx. c Intra-operative ultrasound image in a 9-year-old boy undergoing percutaneous nephrolithotomy showing placement of needle (white arrow) into calyx to obtain access. d Image of wire through nephrostomy tract in the same boy
Source publication
Pediatric urolithiasis is on the rise globally and incidence rates have risen by 6–10% annually over the past couple of decades. Given the increasing incidence, high likelihood of recurrence, and long life expectancy of children, the use of ionizing radiation in the diagnosis, management, and follow up of pediatric urolithiasis has been scrutinized...
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Aspergilloma localised solely to the kidneys is very rare and poses diagnostic and therapeutic challenges. We present the case of a 35-year-old male with a background of urolithiasis, type II diabetes and chronic kidney disease, who was found to have isolated renal aspergilloma associated with obstructing uric acid renal tract calculi. After poor p...
Purpose
We aimed to accurately determine ureteral stricture (US) rates following urolithiasis treatments and their related risk factors.
Methods
We conducted a systematic review and meta-analysis following the PRISMA guidelines using databases from inception to November 2023. Studies were deemed eligible for analysis if they included ≥ 18 years ol...
Purpose:
This study describes the incremental healthcare costs associated with retreatment among adults undergoing ureteroscopy (URS) or percutaneous nephrolithotomy (PCNL) for upper urinary tract stones (UUTS).
Patients and methods:
The IBM® MarketScan® Commercial Database was used to identify adults aged 18-64 years with UUTS treated with URS...
Purpose:
To evaluate the thermal effect of Ho:YAG laser lithotripsy in a standardized in vitro model via real-time temperature measurement.
Methods:
Our model comprised a 20 ml test tube simulating the renal pelvis that was immersed in a 37 °C water bath. Two different laser fibers [FlexiFib (15-45 W), RigiFib 1000 (45-100 W), LISA laser product...
Purpose:
To evaluate and compare flexible ureteroscopy (f-URS) and mini-percutaneous nephrolithotomy (mPNL) for 20-30 mm renal stones in obese patients regarding efficacy and safety.
Methods:
Between May 2011 and June 2017, 254 obese patients who had 20-30 mm kidney stone were consecutively included in the study; 106 patients underwent mPNL and...
Citations
... Kidney ultrasonography (KUS) has been well-documented as a highly reliable, non-invasive diagnostic tool that spares patients exposure to radiation. It is recommended in the evaluation of numerous kidney disorders including hypertension, [1] febrile urinary tract infections, [2] nephrolithiasis, [3] and chronic kidney disease (CKD). However, its utility in nephrotic syndrome (NS) is less clear. ...
Background
Current guidelines do not recommend kidney ultrasonography (KUS) during initial evaluation of nephrotic syndrome (NS) secondary to presumed minimal change disease (pMCD). However, KUS is still frequently obtained. This chart review assessed incidence and impact of abnormal sonographic findings in these patients.
Methods
Patients 1–18 years, newly diagnosed at our institution with NS from pMCD between 2011–2021 were identified. Hypertension, urinalysis, kidney function, and steroid responsiveness data were collected. Imaging findings were abstracted from radiology reports. Clinical impact of KUS was defined by actions taken in response to KUS.
Results
173 patients identified with new NS; 98 met inclusion criteria. 54% had KUS during initial encounter. Demographic and laboratory data did not differ between those with and without KUS. KUS were abnormal in 45% of studies: increased kidney echogenicity (39.6%) and nephromegaly (35.8%) were the most common abnormal findings. Decreased corticomedullary differentiation, lobular kidney contour, solitary simple kidney cyst, and mild unilateral hydronephrosis were each noted on a single KUS. The latter two were deemed the only actionable findings. Steroid resistance was not associated with either nephromegaly or abnormal echogenicity.
Conclusions
Our data showed no clinically relevant ultrasound findings causing deviations from the standard of care for pMCD. There was no association between KUS findings and steroid resistance. These data suggest that there is little to no benefit from kidney ultrasound imaging in patients with pMCD upon initial presentation.
... This equipment can be incorporated into the therapy head of some lithotripters. Furthermore, other strengths are the identification of the target and maintenance of an optimal position of the patient throughout the procedure by using realtime ultrasound or continuous fluoroscopy (25). Of note, due to the poor radiopaque appearance on fluoroscopic imaging, ultrasound-guided had a higher success rate than fluoroscopicguided ESWL when treating pediatric cysteine stones (26). ...
The incidence of pediatric urolithiasis (PU) is growing worldwide. The corresponding therapeutic methods have become a research hot spot in pediatric urology. PU has the characteristics of abnormal metabolism, easy recurrence, and immature urinary system development, which make its treatment different from that of adults. Pediatric urologists should select the optimal treatment modality to completely remove the stones to prevent recurrence. Currently, the curative treatments of PU include extracorporeal shock wave lithotripsy (ESWL), ureteroscopy, retrograde intrarenal surgery, percutaneous nephrolithotomy (PCNL), laparoscopic, robot-assisted laparoscopic, and open surgery. This review aims to conduct a therapeutic update on the surgical interventions of both pediatric renal and ureteric stones. It accentuates that pediatric surgeons or urologists should bear in mind the pros and cons of various minimally invasive surgical treatments under different conditions. In the future, the treatment of PU will be more refined due to the advancement of technology and the development of surgical instruments. However, a comprehensive understanding of the affected factors should be taken into account by pediatric urologists to select the most beneficial treatment plan for individual children to achieve precise treatment.
... delay in the diagnosis. Ultrasonography is the preferred preliminary investigation, as it is non-invasive, easily available, and repeatable [5]. Thorough metabolic evaluation of all children who have renal stones is the linchpin if morbidity and long-term renal complications are to be prevented. ...
Objective: To determine the frequency of various metabolic abnormalities in children with urinary lithiasis. Methods: This cross-sectional study was conducted at the Armed Forces Institute of Urology, Rawalpindi, from 30 January 2017 to 1 February 2020. A total of 1355 children who were aged 4 to 14 years and who had renal stones were included, while those with urinary tract infections, posterior urethral valve, pelvi-ureteric junction obstruction, reflux disease, and chronic renal failure were excluded. Twenty-four-hour urine samples were analyzed for urinary uric acid, calcium, oxalate, citrate, and magnesium. Demographics and metabolic abnormalities—hypercalciuria, hyperoxaluria, hypocitraturia, hyperuricosuria, and hypomagnesuria—were noted and analyzed. Results: The study analysis included 1355 patients. Low urine volume was observed in 465 (34.3%) of the patients. Three hundred nine patients (22.8%) had metabolic abnormalities, the most common being hypocitraturia (184, 59.5%) followed by hypercalciuria (136, 44%) and hypomagnesuria (126, 40.8%). Mean age of presentation, disease duration, recurrent bilateral stones were found significantly different in those having metabolic abnormalities (7.81±2.25 versus 8.76±2.50 P < 0.001, 7.73±1.50 versus 8.43±1.54 P < 0.001, 19.4 versus 2.4% P < 0.001 respectively). No significant difference was found in frequency of abnormal urinary metabolic parameters between boys and girls (P > 0.05) or, upon data stratification, on the basis of disease duration, stone laterality, and recurrence. Conclusion: Metabolic abnormalities were found in 22.8% % of children presenting with urinary lithiasis. The most frequent abnormality observed was hypocitraturia followed by hypercalciuria and hypomagnesuria. Early identification helps manage such patients appropriately, mitigating long-term sequelae.
... CT is considered the gold standard for the diagnosis of renal stones in adults; however, it is advisable to employ strategies that limit this radiation exposure in children. 6 Ultrasound also has the additional advantages including availability and lower cost. A study by Passerotti et al prospectively evaluated the ability of ultrasound to detect renal stones when compared to CT. ...
Introduction:
Abdominal pain is a common complaint in the emergency department. Point-of-care ultrasound (POCUS) is a rapid modality to evaluate for the etiology.
Case report:
A teenage male presented with symptoms concerning for appendicitis. POCUS revealed a non-peristalsing, non-compressible, tubular structure containing an echogenic stone. This was determined to be a ureteral stone within a dilated ureter, not appendicitis.
Conclusion:
We propose a syndromic sonographic approach to right lower quadrant pain (RLQ) that includes the gallbladder, right kidney, bladder, and right adnexa, in addition to RLQ landmarks. This case emphasizes the value of such an approach to avoid diagnostic error.
... Another improvement has been the improved identification of the target and maintenance of an optimal position of the patient throughout the procedure by the use of continuous fluoroscopy or real-time ultrasound with lower radiation exposure (36). ...
Urolithiasis has always been a fascinating disease, even more so in children. There are many intriguing facets to this pathology. This article is a nonsystematic review to provide an update on the surgical management of pediatric urolithiasis. It highlights the pros and cons of various minimally invasive surgical options such as extracorporeal shockwave lithotripsy (ESWL), retrograde intrarenal surgery (RIRS), percutaneous nephrolithotomy (PCNL), laparoscopy, and robotics. This article also describes the various intracorporeal disintegration technologies available to fragment the stone, including the newer advancements in laser technology. It also emphasizes the cost considerations especially with reference to the emerging economies. Thus, this manuscript guides how to select the least-invasive option for an individual patient, considering age and gender; stone size, location, and composition; and facilities and expertise available.
... The factors contributing to the occurrence of urolithiasis among Uyghur children are complicated and mainly include socioeconomic status, racial difference, environmental condition, lifestyle change, diet habit, biochemical metabolic disturbance and genetic diversity [2,[7][8][9]. Biochemical metabolic abnormalities play a crucial role in stone formation in children [10,11]. A high proportion of upper urinary tract stones was found correlated with biochemical metabolic disturbance, which may be derived from the dietary and environmental factors [12,13]. ...
Because of lacking studies of urolithiasis in children, we detected the biochemical metabolic levels and FokⅠ polymorphisms in the vitamin D receptor (VDR) in Uyghur children with urolithiasis, and evaluated the associations of biochemical metabolic levels with FokⅠ genotypes. We included 142 Uyghur children (108 males) under age 14 years with a diagnosis of urolithiasis and 238 Uyghur children (154 males) under age 14 years without a history of urolithiasis as controls. Baseline information and data for serum and urine parameters were obtained from medical records. PCR-restriction fragment length polymorphism (PCR-RFLP) was used to analyze the VDR FokⅠ polymorphisms. In univariate analyses adjusting for age and sex, carbon dioxide combining power (CO2CP) (odds ratio [OR] = 1.13, 95% confidence interval [CI]: 1.07-1.19), serum magnesium (Mg) (OR = 1.27, 95% CI: 1.03-1.56) and serum chlorine (Cl) (OR = 0.93, 95% CI: 0.88-0.97) were related to Uyghur children urolithiasis risk. A multiple logistic regression model showed CO2CP (OR = 1.17, 95% CI: 1.09-1.26), levels of uric acid (OR = 1.01, 95% CI: 1.00-1.01) and serum sodium (Na) (OR = 0.90, 95% CI: 0.82-0.99) were associated with pediatric urolithiasis. The risk of urolithiasis was increased with the F versus f allele overall (OR = 1.42; 95% CI: 1.01-2.00) and for males (OR = 1.52, 95% CI: 1.02-2.27). However, metabolic levels did not differ by FokⅠ genotypes. In our population, CO2CP and levels of uric acid and serum Na as well as polymorphism of the F allele of the VDR FokⅠ may provide important clues to evaluate the risk of urolithiasis in Uyghur children.
... Almost 90% of the calculi can be diagnosed by ultrasound, carried out by an experienced professional, according to a recent review by Morrison et al. 16 According to these authors, ultrasound to diagnose urolithiasis in children has sensitivity of 76% and specificity of 100%, in comparison to tomography, whose sensitivity is 98%, especially for calculi located in the ureter. 16 These authors also suggest that tomography be reserved only for the preoperative investigation and, in dubious cases, with protocols of low doses of radiation. ...
... Almost 90% of the calculi can be diagnosed by ultrasound, carried out by an experienced professional, according to a recent review by Morrison et al. 16 According to these authors, ultrasound to diagnose urolithiasis in children has sensitivity of 76% and specificity of 100%, in comparison to tomography, whose sensitivity is 98%, especially for calculi located in the ureter. 16 These authors also suggest that tomography be reserved only for the preoperative investigation and, in dubious cases, with protocols of low doses of radiation. 16 In this study, abdominal or urinary tract ultrasound were the most used radiological examinations for diagnostic confirmation -test recommended by the literature for not exposing the patient to radiation, and because the size of non-visualized calculi is clinically insignificant. ...
... 16 These authors also suggest that tomography be reserved only for the preoperative investigation and, in dubious cases, with protocols of low doses of radiation. 16 In this study, abdominal or urinary tract ultrasound were the most used radiological examinations for diagnostic confirmation -test recommended by the literature for not exposing the patient to radiation, and because the size of non-visualized calculi is clinically insignificant. 16 On the other hand, 63% of the patients studied by Tasian and Copelovitch underwent computed tomography, 17 whereas, in this study, 41.5% of the patients did so, showing the frequent use of this examination for diagnosis. ...
Objective
To describe the frequency, clinical profile and treatment of patients with urolithiasis in the Pediatric Nephrology Department of a public state hospital in Rio de Janeiro, Brazil.
Methods
Retrospective study. Data from pediatric patients (age: 1 month - 18 years) with urolithiasis admitted between January/2012 and December/2014 were reviewed from hospital charts. The studied variables were: demographic and anthropometric data, clinical status, family history of urolithiasis, urinary tract infection and use of lithogenic drugs, diagnostic procedures, associated abnormalities, metabolic disorders, treatment and recurrence.
Results
The frequency of urolithiasis was 13.6%. Main characteristics of the patients: male gender, white race, eutrophy, aged between 5 and 10 years, family history of urolithiasis, previous urinary infection and spontaneous stone passage. Abdominal and flank pain and macroscopic hematuria were the most common complaints. The most frequent metabolic disorders were hypercalciuria, hyperuricosuria and hypocitraturia. Hypocitraturia was associated with previous urinary infection (p=0.004). Abdomen/urinary tract ultrasonography was the most commonly used diagnostic test. Hydronephrosis occurred in 54.4% of the cases, 81.1% of the stones were in the kidneys, and bilateral stones were associated to a family history of urolithiasis (p=0.030). Recurrence rate was 29.3% (most patients had a metabolic disorder). In 12.3%, the patients underwent lithotripsy, 24.5% were surgically treated (mainly pyelolithotomy), and only 7.6% had their stones analyzed (calcium oxalate was the main finding in the examined stones).
Conclusions
The frequency of urolithiasis in these pediatric patients was similar to that reported by the literature. A metabolic evaluation is required and the composition of stones should be better evaluated.
... In last years our use of intravenous pyelography significantly decreased. While CT is still considered the gold standard in adults, for children and adolescents, CT should be reserved for cases where stone disease is highly suspected despite a negative ultrasound or prior to invasive surgery for preoperative planning when a stone is identified on ultrasound [13]. CT found an indication more and more in our patients especially with the increase of complex form of uropathie. ...
Introduction: Pediatric urolithiasis remains endemic in low-resource countries affecting children <1 to 15 years.
This study aimed to investigate the diagnosis and the treatment options of pediatric urolithiasis and compare thatwith the literature.
Materials and methods: This study retrospectively evaluated patients who had been diagnosed with urolithiasis
in the in department of pediatric emergency and reanimation and the department of pediatric surgery in Hedi Chaker hospital in Sfax between 2001 and 2016.
Results: Over 16 years period, we diagnosed and managed 78 children with urolithiasis. 44 were male (56%)
and 34 were female (44%). The median age was 54 months (4 to 144 months). Family history of urolithiasis was found in 23 patients (29.5%). The diagnosis of urolithiasis was made after Urinary tract infection in 23 (29.5%), abdominal pain in 16 (20.5%), Hematuria in 9 (11.5%), nephritic colic in 8 (10.5%), dysuria in 11(14%) and after antenatal diagnosis of malformative uropathies in 11 (14%) patients. The treatment were surgery in 32, medical in 30, LEC and endoscopy in 8 patients. The mean of follow up was 36 months and we had 11 recurrent urolithiasis.
Conclusion: Pediatric urolithiasis remains a devastating health problem. Their management requires more
exploration especially in the etiology research for a best management.
... In last years our use of intravenous pyelography significantly decreased. While CT is still considered the gold standard in adults, for children and adolescents, CT should be reserved for cases where stone disease is highly suspected despite a negative ultrasound or prior to invasive surgery for preoperative planning when a stone is identified on ultrasound [13]. CT found an indication more and more in our patients especially with the increase of complex form of uropathie. ...
Introduction: Pediatric urolithiasis remains endemic in low-resource countries affecting children <1 to 15 years. This study aimed to investigate the diagnosis and the treatment options of pediatric urolithiasis and compare that with the literature.
Materials and methods: This study retrospectively evaluated patients who had been diagnosed with urolithiasis in the in department of pediatric emergency and reanimation and the department of pediatric surgery in Hedi Chaker hospital in Sfax between 2001 and 2016.
Results: Over 16 years period, we diagnosed and managed 78 children with urolithiasis. 44 were male (56%) and 34 were female (44%). The median age was 54 months (4 to 144 months). Family history of urolithiasis was found in 23 patients (29.5%). The diagnosis of urolithiasis was made after Urinary tract infection in 23 (29.5%), abdominal pain in 16 (20.5%), Hematuria in 9 (11.5%), nephritic colic in 8 (10.5%), dysuria in 11(14%) and after antenatal diagnosis of malformative uropathies in 11 (14%) patients. The treatment were surgery in 32, medical in 30, LEC and endoscopy in 8 patients. The mean of follow up was 36 months and we had 11 recurrent urolithiasis.
Conclusion: Pediatric urolithiasis remains a devastating health problem. Their management requires more exploration especially in the etiology research for a best management.
The incidence of kidney stones in children is increasing. Approximately two-thirds of pediatric cases have a predisposing cause. Children with recurrent kidney stones have an increased higher risk of developing chronic kidney. A complete metabolic workup should be performed. Ultrasound examination is the initial imaging modality recommended for all children with suspected nephrolithiasis. A general dietary recommendation includes high fluid consumption, dietary salt restriction, and increased intake of vegetables and fruits. Depending on size and location of the stone, surgical intervention may be necessary. Multidisciplinary management is key to successful treatment and prevention.
