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Aktuelle Aspekte zur Steintherapie im Kindesalter

Current aspects in pediatric urolithiasis treatment

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Zusammenfassung

Im Vergleich zu Erwachsenen ist das Harnsteinleiden bei Kindern selten (1–2 % aller Harnsteine treten im Kindesalter auf). Grundsätzlich können heute alle für den Erwachsenen zur Verfügung stehenden Behandlungsmethoden auch bei Kindern angewandt werden. Aufgrund einiger Besonderheiten der Anatomie und Physiologie des kindlichen Harntrakts ist die Differentialindikation der verfügbaren Behandlungsverfahren jedoch anders als bei Erwachsenen. Asymptomatische Nierenkonkremente werden in der Regel nicht behandelt, sondern beobachtet. Bei Kindern gehen mehr Steine spontan ab als bei Erwachsenen. Wenn ein Spontanabgang nicht möglich ist oder nicht stattfindet, kommen nicht-invasive und minimal-invasive Verfahren zum Einsatz. Die extrakorporale Stoßwellenlithotripsie (ESWL) ist bei Kindern auch in Zeiten der modernen Endourologie das Mittel der Wahl für die meisten Steinsituationen. Endoskopische Verfahren können aber auch im Kindesalter, selbst bei kleinsten Kindern, sicher zum Einsatz kommen. Bei größeren und aus Zystin oder Whewellit bestehenden Nierensteinen ist die perkutane Nephrolitholapaxie (PCNL) die Therapie der ersten Wahl, bei distalen Harnleitersteinen die Ureterorenoskopie (URS). Laparoskopische und offene Steinoperationen sind Einzelfällen vorbehalten, insbesondere bei operationsbedürftigen Begleitpathologien. Blasensteine werden transurethral oder perkutan therapiert.

Abstract

Compared with adults, urolithiasis is quite rare in children (1–2% of all urinary stones occur during childhood). In principle, all therapy modalities for adults can also be used in children. However, due to some anatomic and functional peculiarities in children, the differential indication for the various treatment modalities differ. As a rule, asymptomatic renal stones are not treated but observed. More urinary stones pass spontaneously in children compared with adults. If spontaneous passage is not possible or does not occur, noninvasive and minimally invasive techniques are indicated. Extracorporeal shock wave lithotripsy is the therapy of choice in most instances. Today, endoscopic techniques, however, can be safely used even in very small infants. For larger renal stones and those consisting of cysteine or whewellite, percutaneous nephrolithotomy (PCNL) is the therapy of choice, and for distal ureteral stones ureteroscopy is the method of choice. Laparoscopic and open surgery are reserved for very rare cases, especially with concomitant pathologies. Bladder calculi are treated by transurethral or suprapubic lithotripsy.

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Authors and Affiliations

  1. Regiomed-Klinikum Coburg, Regiomed Medical School Coburg, Universität Split, Ketschendorfer Str. 33, 96450, Coburg, Deutschland

    W. L. Strohmaier

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Correspondence to W. L. Strohmaier.

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W. L. Strohmaier gibt an, dass kein Interessenkonflikt besteht.

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Strohmaier, W.L. Aktuelle Aspekte zur Steintherapie im Kindesalter. Urologe 59, 289–293 (2020). https://doi.org/10.1007/s00120-020-01132-w

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