The incidence of stone disease in the paediatric population has been increasing worldwide, particularly for the adolescent age group (12–17 years of age). In this article the authors discussed the evolutions of percutaneous nephrolithotomy (PCNL) and ureteroscopy (URS) in children. Hypocitraturia, hypercalciuria, and oliguria are the most common causes identified in paediatric 24-hour urine assessment. Most stones in children are calcium-containing with a much smaller proportion of uric acid compared with adults. In 2012, AUA guidelines identified US as the first-line screening tool for urolithiasis with CT scan reserved for situations in which the diagnosis is unclear or for surgical planning. Guidelines published in 2007 identify URS as first-line treatment, along with shockwave lithotripsy (SWL), in the management of ureteral and renal calculi in the paediatric patient. The 4.5-Fr Wolf ureteroscope has a 6° lens with a 3.3-Fr working channel that accommodates a 150-μm laser fibre or a 3-Fr basket. An additional advantage of the 4.5-Fr scope was a drastically decreased need for ureteral dilation. The ‘mini perc’ system has proven to be a feasible option in selected paediatric patients with improving rates of stone clearance and decreased complications. The ‘micro perc’ consists of a 4.85-Fr single system that contains an ‘all-seeing’ needle that allows for visual confirmation of collecting system entry during access and provides a working channel for lithotripsy through a very small access sheath. Some have reported success with supine PCNL in the paediatric patient, although this certainly needs to be done selectively based on anatomic considerations.
Tackling stones in children: is it difficult to crack on?
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