Pediatric urolithiasis : dissolution therapy

Abstract EN

Aim of Study : To evaluate prospeetively the efficacy of chemical dissolution therapy in the management of pediatric Urolithiasis.

Materials and Methods : From February 1997 to July 2002, we evaluated the outcome of the management of 152 children with urinary tract calculus disease, presenting to Ain-Shams university ; paediatric surgery unit.

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Their ages ranged between 9 months to 12 years (mean 7.3 years).

All our patients had a complete urinary and blood metabolic assay for their urolithiasis.

Chemical analysis of passed stones or stone gravels was done when possible.

A full radiological assessment of the urinary tract was done for all our patients.

They were divided into 3 groups: Group 1, 61 patients (40.1 %) with radiolucent stones.

Group II, 33 patients (21.7 %) with radio-opaque calcium oxalate stones with hyperuricosurea, and group III, 58 patients (38.2 %) with radio-opaque calcium oxalate stones without hyperuricosurea.

The stones sizes ranged from 4 to 13mm (mean 7.2 mm).

Medical dissolution therapy orally using potassium citrate was offered to all patients of the three groups.

The non-responders patients to the oral dissolution therapy were treated by different treatment modalities.

Results : Out of 61 patients in group I, 54 (88.5 %) were cleared of their stones within a period of 8 weeks, while 2 (3.3 %) needed shockwave lithotripsy (ESWL) and 5 (8.2 %) needed different surgical procedures.

Out of the 33 patients of group II, 13 patients (39.4 %) were cleared of their stones, 16 (48.5 %) needed ESWL and 4 (12.1 %) needed surgery'.

In the 67 patients who responded well to dissolution therapy, 48 patients showed disappearance of their stones on the follow up Ultrasound scan (U/S), while 19 passed stone gravels or stones of smaller sizes than that originally detected.

Dissolution therapy had shown disappointing results in group III patients, so out of 58 patients, 38 (65.5 %) had ESWL, 4 (6.9 %) underwent endoscopic stone extraction, and 16 (27.6 %) had surgical procedures.

Only 110 patients followed up regularly for a period ranged from 5 months to 5 years (mean 1.8 year) with a recurrence rate in patients who responded to dissolution therapy of 8% while it was 1 5 % in patients received other treatment modalities.

Conclusion : Medical dissolution therapy has a valid role in treatment of radiolucent stones and in a considerable percentage of radio-opaque calcium oxalate stones with uricosuria and has a unique advantage of minimizing the recurrence rate.