الفهرس | Only 14 pages are availabe for public view |
Abstract Over the past several years there have been an increasing incidence of children with stones. Causative factors of pediatric stone disease include: metabolic causes, non metabolic causes and idiopathic stone disease. Hypercalciuria is major metabolic risk factor that occurs in 34–97% of children with stones and an identifiable metabolic etiology. Other metablic causes include; hyperoxaluria, cystinuria, hyperuricosuria, hypocitruria and hypomagnisuria. Non metablic causes include; urinary infections, structural abnormalities, diets, drugs and diseases which may lead to or associated with urinary stones. Clinical presentations of pediatric stone disease include: pain, hematuria, infection, urinary retention or incidental discovery of asymptomatic stones. Urine analysis and urine culture, basic laboratory tests and imagings are the base line for diagnosis of pediatric urolithiasis. Being high risk of stone recurrence; Children with nephrolithiasis are a clear indication for metabolic evaluation. Imaging modalities include: conventional radiography (KUB), ultrasongraphy, intravenous pyelography, computed tomography, magnetic resonance imaging and renal radio isotope scanning. Recently, there has been interest in development of lowdose CT techniques for use in the diagnosis of renal stones. If a 24-hour collection is difficult, especially in younger children, urinary standards based on single specimens, corrected to urine creatinine concentration, have been developed. Pediatric urolithiais could be managed nonsurgically and surgically, stones associated with sever sepsis, colic resistant to analgesics, urinary retention, obstruction of solitary kidney and infected stones are examples of indications of urgent surgical interventions. Shock wave lithotripsy should be the treatment modality for all renal stones less than 1 cm or <150 mm2, soft renal stones (HU< 900 mm2 on CT scan) between 1 to 2 cm with normal renal function, no infection and favorable anatomy. Indications for PCNL in children are similar to those in adults and include large burden stone more than 2cm. Come into light the less invasive percutaneous access to the pelvicalyceal cavities as the“mini-perc” technique which worth its wide use with pediatric urolithiasis. Ureter-renoscopy, open surgical stone extraction and laparoscopy are other invasive procedures for stone removal. Bladder stones could be managed endoscopically but open approach being easier and less operative time for large stones. |