Update on Urinary Stones in Children: Current and Future Concepts in Surgical Treatment and Shockwave Lithotripsy

Abstract

Context: Miniaturized instrumentation used for endoscopic treatment of urinary stone disease in children has been readily adopted in clinical practice. However, there is a need to optimize and individualize the surgical approach according to the patient's age, body habitus, and stone characteristics. Promising novel equipment and techniques will continue to advance the surgical care of these children.

Objective: To review the literature regarding surgical and shockwave lithotripsy (SWL) treatment of urinary stone disease in children and provide an overview on future treatment innovations.

Evidence acquisition: We conducted a nonsystematic review of the literature using the PubMed database. The search focused on the most recent two decades to provide a contemporary overview of surgical outcomes.

Evidence synthesis: Although SWL use has proportionally decreased over time, it remains an important treatment option for kidney stones <2cm and upper ureteral calculi, with success rates between 49% and 97%. Rigid/semirigid ureteroscopy is the first-line therapy for distal ureteral stones and has success rates comparable to SWL for upper ureteral stones. Success rates between 80% and 100% are achieved with retrograde intrarenal surgery (RIRS) for kidney stones <2cm but may require pre-stenting in smaller children. Mini percutaneous nephrolithotomy (PNL) is the most efficient technique for treating kidney stones in children. Micro-PNL and ultramini-PNL are valuable alternatives, especially for smaller renal stones.

Conclusions: Modern endoscopic treatment options together with SWL allow personalized management of stone disease in the pediatric population. Future technical improvements on the horizon offer the promise of increasing the efficiency of current procedures while minimizing complications.

Patient summary: Miniaturization of the instruments used for treatment of stone disease in children provides a variety of options for clinical practice. Rather than routinely using a single technique, personalized treatment is recommended to increase the success of each procedure.

Keywords: Children; Microperc; Mini percutaneous nephrolithotomy; Percutaneous nephrolithotomy; Retrograde intrarenal surgery; Shockwave lithotripsy; Ureteroscopy.