Abstract
The initial aim in stone management is relief of symptoms.
Secondary aims:
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1.
Achieve stone-free status.
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2.
Reduce or prevent stone recurrence.
Summary of evidence for these aims:
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The most common presenting complaint is abdominal pain. Our review found no study evaluating medical therapy to control acute renal colic in children.
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Although studies in adults conclude that alpha-blockers promote spontaneous stone passage, evidence in children is not conclusive.
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Two studies reported spontaneous stone passage in 34 and 47 % of children.
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Reported stone-free rates for renal stones <1 cm were 63–86 % for shock wave lithotripsy (SWL) and 50–90 % for ureteroscopy. Efficiency quotients (EQ) were only reported for SWL, with approximately 25 % needing additional procedures. However, at least a third of patients undergoing ureteroscopy needed a period of stenting to dilate the ureter before the stone could be accessed, and most had postoperative stents, meaning some had as many as three procedures to achieve stone-free status.
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Unlike adults, lower pole stones in children are as effectively treated by SWL as those in other renal locations.
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One trial compared monotherapy percutaneous nephrolithotomy (PCNL) to SWL for renal stones 1–2 cm, finding stone-free rates greater with PCNL, 95 % versus 85 %.
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One trial found no difference in stone recurrence in those stone-free versus having fragments <5 mm after SWL.
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Recurrence after stone-free status occurred in ≤10–33 % of patients. One study reported significantly fewer recurrences with potassium citrate therapy.
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Low-sodium high-potassium diet resolved hypercalciuria in 50 % of children, but was difficult to maintain.
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Indications and duration of medical therapy with potassium citrate or thiazides are not defined for children.
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Our review found no study evaluating stone recurrence rates in children with versus without 24-h urine stone-risk profile determinations in first-time pediatric stone formers.
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Baker, L.A., Bush, N.C. (2013). Urolithiasis. In: Snodgrass, W. (eds) Pediatric Urology. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-6910-0_17
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