Imaging modalities and treatment of paediatric upper tract urolithiasis: A systematic review and update on behalf of the EAU urolithiasis guidelines panel.
Children
Diagnostic imaging
Treatment
Urinary stones
Journal
Journal of pediatric urology
ISSN: 1873-4898
Titre abrégé: J Pediatr Urol
Pays: England
ID NLM: 101233150
Informations de publication
Date de publication:
Oct 2020
Oct 2020
Historique:
received:
19
01
2020
revised:
29
06
2020
accepted:
02
07
2020
pubmed:
3
8
2020
medline:
22
6
2021
entrez:
3
8
2020
Statut:
ppublish
Résumé
Prompt diagnosis and treatment of paediatric urolithiasis are required to avoid long term sequelae of renal damage. To systematically review the literature regarding the diagnostic imaging modalities and treatment approaches for paediatric urolithiasis. PubMed, Science Direct, Scopus and Web of Science were systematically searched from January 1980-January 2019. 76 full-text articles were included. Ultrasound and Kidney-Ureter-Bladder radiography are the baseline diagnostic examinations. Non-contrast Computed Tomography (CT) is the second line choice with high sensitivity (97-100%) and specificity (96-100%). Magnetic Resonance Urography accounts only for 2% of pediatric stone imaging studies. Expectant management for single, asymptomatic lower pole renal stones is an acceptable initial approach, especially in patients with non-struvite, non-cystine stones<7 mm. Limited studies exist on medical expulsive therapy as off-label treatment. Extracorporeal shock wave lithotripsy (SWL) is the first-line treatment with overall stone free rates (SFRs) of 70-90%, retreatment rates 4-50% and complication rates up to 15%. Semi-rigid ureteroscopy is effective with SFRs of 81-98%, re-treatment rates of 6.3-10% and complication rates of 1.9-23%. Flexible ureteroscopy has shown SFRs of 76-100%, retreatment rates of 0-19% and complication rates of 0-28%. SFRs after first and second-look percutaneous nephrolithotomy (PNL) are 70.1-97.3% and 84.6-97.5%, respectively with an overall complication rate of 20%. Open surgery is seldom used, while laparoscopy is effective for stones refractory to SWL and PNL. Limited data exist for robot-assisted management. In the initial assessment of paediatric urolithiasis, US is recommended as first imaging modality, while non-contrast CT is the second option. SWL is recommended as first line treatment for renal stones <20 mm and for ureteral stones<10 mm. Ureteroscopy is a feasible alternative both for ureteral stones not amenable to SWL as well as for renal stones <20 mm (using flexible). PNL is recommended for renal stones >20 mm.
Sections du résumé
BACKGROUND
BACKGROUND
Prompt diagnosis and treatment of paediatric urolithiasis are required to avoid long term sequelae of renal damage.
OBJECTIVE
OBJECTIVE
To systematically review the literature regarding the diagnostic imaging modalities and treatment approaches for paediatric urolithiasis.
STUDY DESIGN
METHODS
PubMed, Science Direct, Scopus and Web of Science were systematically searched from January 1980-January 2019. 76 full-text articles were included.
RESULTS
RESULTS
Ultrasound and Kidney-Ureter-Bladder radiography are the baseline diagnostic examinations. Non-contrast Computed Tomography (CT) is the second line choice with high sensitivity (97-100%) and specificity (96-100%). Magnetic Resonance Urography accounts only for 2% of pediatric stone imaging studies. Expectant management for single, asymptomatic lower pole renal stones is an acceptable initial approach, especially in patients with non-struvite, non-cystine stones<7 mm. Limited studies exist on medical expulsive therapy as off-label treatment. Extracorporeal shock wave lithotripsy (SWL) is the first-line treatment with overall stone free rates (SFRs) of 70-90%, retreatment rates 4-50% and complication rates up to 15%. Semi-rigid ureteroscopy is effective with SFRs of 81-98%, re-treatment rates of 6.3-10% and complication rates of 1.9-23%. Flexible ureteroscopy has shown SFRs of 76-100%, retreatment rates of 0-19% and complication rates of 0-28%. SFRs after first and second-look percutaneous nephrolithotomy (PNL) are 70.1-97.3% and 84.6-97.5%, respectively with an overall complication rate of 20%. Open surgery is seldom used, while laparoscopy is effective for stones refractory to SWL and PNL. Limited data exist for robot-assisted management.
CONCLUSIONS
CONCLUSIONS
In the initial assessment of paediatric urolithiasis, US is recommended as first imaging modality, while non-contrast CT is the second option. SWL is recommended as first line treatment for renal stones <20 mm and for ureteral stones<10 mm. Ureteroscopy is a feasible alternative both for ureteral stones not amenable to SWL as well as for renal stones <20 mm (using flexible). PNL is recommended for renal stones >20 mm.
Identifiants
pubmed: 32739360
pii: S1477-5131(20)30413-7
doi: 10.1016/j.jpurol.2020.07.003
pii:
doi:
Types de publication
Journal Article
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
612-624Informations de copyright
Copyright © 2020 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.
Déclaration de conflit d'intérêts
Conflict of interest Aleš Petřík has received speaker honoraria from Olympus Czech Group, S.R.O., Cook Medical Europe Ltd., fellowship and travel grants from Astellas and consultant fees from Olympus and Cook Medical; Christian Seitz has received consultant fees from Astellas and speaker honoraria from Rowa Wagner; Andreas Neisius has received fellowships/travel grants from Storz, Wolf, Astellas, Astellas, Boston Scientific, Novartis, Janssen, Eichard Wolf, Karl Storz, consultant fees from Novartis, MSD, Roche, speaker honorarium from Siemens Healthcare, Pfizer, Astellas, Ferring, Boston Scientific Europe, Pfizer, MSD, Boston Scientific and has participated in trials for Bayer, Kendle, Merck, Astellas, MSD, Kendle; Kay Thomas has participated in trials for TISU.