Pediatric Calculi: Cause, Prevention and Medical Management

Cesare M. Scoffone; Cecilia M. Cracco

Disclosures

Curr Opin Urol. 2018;28(5):428-432. 

In This Article

The Evolving Epidemiology of Pediatric Nephrolithiasis

The occurrence of nephrolithiasis in the pediatric population is actually rare, being the reported incidence between 1 and 2.7%,[9] but it is worthwhile to underline that this overall incidence increased nearly five-fold over the last 20 years.[10] During the last 10 years, there have been reports of four-fold increase in the number of children evaluated for nephrolithiasis, and of those, a seven-fold increase in diagnosis of urinary stone disease.[11] During the last 25 years, the incidence of nephrolithiasis in children has steadily increased 6–10% annually, and is now 50 per 100 000 adolescents.[1]

Nephrolithiasis is historically more common in boys than in girls, similarly to what happens with the adults, in which the lifetime prevalence is 10% for men and 4% for women,[2,12,13] but in the last years, this discrepancy is slowly disappearing: in fact, an increasing number of girls present with renal stone disease.[2,14] The current median age of nephrolithiasis onset is 4.4 years for boys, 7.3 years for girls.[15]

Following the diagnosis of nephrolithiasis, stone removal is essential. Although the management of urinary stones in children poses specific technical challenges to the urologist, the use of techniques like shock wave lithotripsy, retrograde ureterolithotripsy and retrograde intrarenal surgery, percutaneous nephrolithotomy and endoscopic combined intrarenal surgery is well accepted as safe, effective and minimally invasive. Their aim is complete stone clearance for prevention of stone recurrence (currently up to 16–44% in the literature[2]) on one hand, minimal morbidity and long-term preservation of renal function on the other hand.

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