小兒泌尿道結石手術治療與案例分享-單一醫學中心經驗
蔡易辰、蘇家震、劉建良、黃冠華
奇美醫療財團法人奇美醫學中心 外科部 泌尿科
Pediatric urolithiasis surgical treatment and experience sharing-single medical center cases experiences
I-Chen Tsai, Chia-Cheng Su, Chien-Liang Liu, Steven K. Huang
Divisions of Urology, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan;
Purpose: Pediatric urolithiasis cases had increased over the past two decades. The morbidity and damage of kidney have a strong relationship with untreated urolithiasis in children. We investigated the pediatric urolithiasis cases in Chi Mei Hospital. The surgical managements and the case experiences in single medical center are introduced.
Patients and Methods: During 2014 to 2019, there were 21 children who were diagnosed of urolithiasis under surgical treatments. We excluded the ones whose age were over 15 years old, whereas 5 children were included, that their ages were below 10-year-old. Surgical managements were determined by the stone size and location. Clinical features, calculus localization, family history, presence of anatomic abnormalities, and urinary metabolic risk factors were evaluated.
Results: Among our five cases, they all presented acute abdominal pain. UTI and different grade of hydronephrosis was also found. URS was performed after the determination of the stone size and location. Ureteroscopic retrieval of stone was done using a Richard Wolf rigid ureteoscope of size 4.5/6 Fr with 2.5 Fr and 3 Fr working channels, which depended on the body height and weight of the children. Post URS JJ stent(4.7Fr. 12cm) placement were done at 4 patients, whereas one was placed with No.3 RP. After the surgical treatment, we keep follow up the stone-free condition of these children. The recurrent stone formation was found in one kid, with following up the stone size. We also found a child with situs inversus totalis, whose 24h urine revealed hypercalciuria. Metabolic risk factor such as normocalcemic hypercalciuria had significant relationship with the stone formation.
Conclusions: Pediatric urolithiasis should be suspicious while a child presenting the non-specific symptoms such as abdominal pain, hematuria or urinary tract infection. Smaller instruments are feasible and appropriate for the children underwent ureteroscopy. The surgical indication and complication rate were similar compared with adult patients. Metabolic or congenital abnormality should be evaluated for the kids with recurrent urolithiasis. Adequate managements and differentiation of the type of the abnormalities may prevent further renal damage and recurrence.