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Urolithiasis im Kindesalter

Urolithiasis in childhood

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Zusammenfassung

Harnsteine bei Kindern sind selten, nur 1–2 % aller Harnsteine betreffen Kinder und Jugendliche. Es liegen jedoch häufig metabolische Ursachen zugrunde, welche zu einer Rezidivsteinbildung führen können. Kinder mit Harnsteinen sind daher per Definition eine Hochrisikogruppe, weshalb nach dem ersten Steinereignis basierend auf der Steinanalyse eine erweiterte Stoffwechseldiagnostik erfolgen muss. Ziel der Steintherapie bei Kindern sollte die Erzielung einer kompletten Steinfreiheit, die Prävention von Steinrezidiven, der Erhalt der Nierenfunktion, die Kontrolle von Harnwegsinfekten sowie die Korrektur von anatomischen und metabolischen Ursachen sein. Wenn eine aktive Therapie erforderlich ist, kommen prinzipiell die gleichen minimal-invasiven Verfahren wie bei Erwachsenen zur Anwendung. Allerdings zeigt die extrakorporale Stoßwellenlithotripsie bei Kindern bessere Ergebnisse als bei Erwachsenen. Durch die Weiterentwicklung und Miniaturisierung von Ureterorenoskopen und perkutanen Nephroskopen haben auch die endoskopischen Techniken zunehmend ihren Stellenwert in der Steintherapie bei Kindern erhalten.

Abstract

Urinary stone disease is relatively rare in children with an overall incidence of 1-2 %; however, it is often associated with metabolic abnormalities that may lead to recurrent stone formation. Stone analysis and subsequent metabolic evaluation is therefore mandatory for this high-risk group after the first stone event. The objectives of stone management in children should be complete stone clearance, prevention of stone recurrence, preservation of renal function, control of urinary tract infections, correction of anatomical abnormalities and correction of the underlying metabolic disorders. The full range of minimally invasive procedures is available if active stone removal is necessary. The majority of stones in children can be managed either with extracorporeal shock wave lithotripsy which has a higher efficacy in children than in adults, percutaneous nephrolithotomy, ureterorenoscopy or a combination of these modalities while open or laparoscopic surgery is limited to well-selected cases with underlying anatomical abnormalities.

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  1. Urologische Klinik Sindelfingen, Klinikum Sindelfingen-Böblingen, Lehrkrankenhaus der Universität Tübingen, Arthur-Gruber-Straße 70, 71065, Sindelfingen, Deutschland

    T. Knoll

  2. Urologische Klinik, Katharinenhospital, Klinikum Stuttgart, Stuttgart, Deutschland

    U. Humke

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Knoll, T., Humke, U. Urolithiasis im Kindesalter. Urologe 52, 1084–1091 (2013). https://doi.org/10.1007/s00120-013-3165-x

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