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DOI: 10.1055/s-2006-954991
Steintherapie im Kindesalter
Stone Management in ChildrenPublication History
Publication Date:
28 September 2007 (online)
![](https://www.thieme-connect.de/media/uro/200705/lookinside/thumbnails/10.1055-s-2006-954991-1.jpg)
Zusammenfassung
Die Behandlungsmodalitäten in der Therapie der kindlichen Urolithiasis sind einem stetigen Wandel unterworfen. Aufgrund von Effizienz und niedriger Morbidität gilt die ESWL bis heute als Therapie der ersten Wahl bei kindlichen Ureter- und Nierensteinen. Entwicklungen im Bereich minimal invasiver Verfahren eröffnen jedoch zunehmend mehr Behandlungsoptionen. Insbesondere bei der Behandlung distaler Uretersteine muss die extrakorporale Stoßwellenbehandlung als primärer Therapieansatz kritisch überdacht werden. Im Vergleich zur ESWL zeigt die URS in diesem Bereich eine deutlich höhere Effizienz. Auch in der Therapie komplexer und großer Nierensteine sollte vermehrt die Anwendung der mini PCNL erwogen werden. Das Größenverhältnis von Nierenhohlsystem und Instrumentarium limitiert den Einsatz bei Kleinkindern und Säuglingen. Bei geringen Patientenzahlen bleibt die Bereitstellung des Instrumentariums und Anwendung der entsprechenden Techniken größeren Zentren vorbehalten.
Abstract
The extracorporeal shock-wave lithotripsy (ESWL) is still the treatment of choice for almost all stones in children. But with advances in instrumentation, endourological procedures are being performed more frequently in younger patients. Especially in the treatment of distal ureteral stones retrograde ureteroscopy now competes with ESWL. Finally, the recent literature supports percutaneous nephrolithotomy as a safe and effective treatment option for large renal calculi and staghorn calculi. This gives the clinician the opportunity to choose from a wide range of treatment alternatives. Proper treatment planning, technique and availability of appropriate instrumentation are important to achieve an optimal outcome.
Schlüsselwörter
kindliche Urolithiasis - extrakorporale Stoßwellenlithotripsie - Ureterorenoskopie - perkutane Nephrolitholapaxie
Key words
pediatric urolithiasis - extracorporeal shock-wave lithotripsy - retrograde ureteroscopy - percutaneous nephrolithotomy
Literatur
- 1 Al-Busaidy S S, Prem A R, Medhat M. Pediatric staghorn calculi: the role of extracorporeal shock wave lithotripsy monotherapy with special reference to ureteral stenting. J Urol. 2003; 169 629-633
- 2 Al-Busaidy S S, Prem A R, Medhat M, Al-Bulushi A L. Ureteric calculi in children: preliminary experience with holmium:YAG laser lithotripsy. BJUI. 2004; 93 1318-1323
- 3 Afshar K, Mclorie G, Papnikoloaou F, Malek R, Harvey E, Pippi-Salle J L, Bagli D J, Khoury A E, Farhat W. Outcome of small residual stone fragments following shock wave lithotripsy in children. J Urol. 2004; 172 1600-1603
- 4 Aksoy Y, Özbey I, Atmaca A F, Polat O. Extracorporal shock wave lithotripsy in children: experience using a mpl-9000 lithotriptor. World J Urol. 2004; 22 115-119
- 5 Alken P. Harnsteinleiden im Kindesalter. In Hohenfellner R, Thüroff JW, Schulte-Wissermann H (eds). Kinderurologie in Klinik und Praxis. Stuttgart: Thieme 1986: 572-591
- 6 Ather M H, Noor M A, Akhtar S. The effect of intracalyceal distribution on the clearance of renal stones of > or = 20 mm in children after extracorporeal lithotripsy. BJU Int. 2004; 93 827-829
- 7 Bassiri A, Ahmadnia H, Darabi M R, Yonessi M. Transureteral lithotripsy in pediatric practice. J Endourol. 2002; 16 257-260
- 8 Biri H, Kupeli B, Isen K, Sinik Z, Karagolan U, Bozkirli I. Treatment of lower ureteral stones: extracorporeal shockwave lithotripsy or intracorporeal lithotripsy?. J Endourol.. 1999; 3 (2) 77-81
- 9 Boormans J L, Scheepe J R, Verkoelen C F, Verhagen P C. Percutaneous nephrolithotomy for treating renal calculi in children. BJU Int. 2005; 95 (4) 631-634
- 10 Coward R JM, Peters C J, Duffy P G, Corry D, Kellett M J, Choong S, Hoff W G van't. Epidemiology of paediatric renal stone disease in the UK. Arch Dis Child . 2003; 88 962-965
- 11 Dawaba M S, Shokeir A A, Hafez A T, Shoma A M, El-Sherbiny M F, Mokhtar A, Eraky I, El-Kenawy M, El-Kappany H A. Percutaneous nephrolithotomy in children: early and late anatomical and functional results. J Urol. 2004; 172 1078-1081
- 12 Daudon M, Doré J-C, Jungers P, Lacour B. Changes in stone composition according to age and gender of patients: a multivariate epidemiological approach. Urol Res. 2004; 32 (3) 241-247
- 13 Desai M. Endoscopic management of stones in children. Curr Opin Urol. 2005; 15 (2) 107-112
- 14 Desai M, Ridhorkar V, Patel S, Bapat S, Desai M. Pediatric percutaneous nephrolithotomy: assessing impact of technical innovations on safety and efficacy. J Endourol. 1999; 13 359-364
- 15 Diamond D A, Menon M, Lee P H, Rickwood A M, Johnston J H. Etiological factors in pediatric stone recurrence. J Urol. 1989; 142 (2 Pt 2) 606-608
- 16 Dogan H S, Tekgul S, Akdogan B, Keskin M S, Sahin A. Use of holmium:YAG laser for ureterolithotripsy in children. BJUI. 2004; 94 131-133
- 17 Dominicis M, Matarazzo E, Capozza N, Collura G, Caione P. Retrograde ureteroscopy for distal ureteric stone removal in children. BJU Int. 2005; 95 131-133
- 18 Esen T, Krutschik A, Alken P. Treatment update on pediatric urolithiasis. World J Urol. 1997; 15 195-202
- 19 Gofrit O N, Pode D, Meretyk S, Meretyk S, Katz G, Shapiro A, Golijanin D, Wiener D P, Shenfeld O Z, Landau E H. Is the pediatric ureter as efficient as the adult ureter in transporting fragments following extracorporeal shock wave lithotripsy for renal calculi larger than 10 mm?. J Urol. 2001; 166 (5) 1862-1864
- 20 Jayanthi V R, Arnold P M, Koff S A. Strategies for managing upper tract calculi in young children. J Urol. 1999; 162 (3 Pt 2) 1234-1237
- 21 Kroovand R L. Pediatric urolithiasis. Urol Clin North Am. 1997; 24 173-184
- 22 Lam J S, Greene T D, Gupta M. Treatment of proximal ureteric calculi: holmium:YAG laser ureterolithotripsy versus ESWL. J Urol. 2002; 167 1972-1976
- 23 Landau E H, Gofrit O N, Shapiro A, Meretyk S, Katz G, Shenfeld O Z, Golijanin D, Pode D. Extracorporeal shock wave lithotripsy is highly effective for ureteral calculi in children. J Urol. 2001; 165 (6 Pt 2) 2316-2319
- 24 Longo J A, Netto Jr N R. Extracorporeal shock-wave lithotripsy in children. Urology. 1995; 46 (4) 550-552
- 25 Lottmann H B, Archambaud F, Hellal B, Pageyral B M, Cedron M. 99mTechnetium-dimercapto-succinic acid renal scan in the evaluation of potential long-term renal parenchymal damage associated with extracorporeal shock wave lithotripsy in children. J Urol. 1998; 159 (2) 521-524
- 26 Lottmann H B, Archambaud F, Traxer O. The efficacy and parenchymal consequences of extracorporeal shock wave lithotripsy in infants. BJU Int. 2000; 85 311-315
- 27 Lottmann H B, Traxer O, Archambaud F, Mercier-Pageyral B. Monotherapy extracorporeal shock wave lithotripsy for the treatment of staghorn calculi in children. J Urol. 2001; 165 2324-2327
- 28 Mahmud M, Zaidi Z. Percutaneous nephrolithotomy in children before school age: experience of a Pakistani centre. BJU Int. 2004; 94 (9) 1352-1354
- 29 Marberger M, Turk C, Steinkogler I. Piezoelectric extracorporeal shock wave lithotripsy in children. J Urol. 1989; 142 349
- 30 McLorie G A, Pugach J, Pode D, Denstedt J, Bagli D, Meretyk S, D'A Honey R S, Meguerian P A, Shapiro A, Khoury A E, Landau E H. Safety and efficacy of extracorporeal shock wave lithotripsy in infants. Can J Urol. 2003; 10 2051-2055
- 31 Milliner D S, Murphy M E. Urolithiasis in pediatric patients. Mayo Clin Proc. 1993; 68 (3) 241-248
- 32 Mor Y, Elmasry Y E, Kellett M J, Duffy P G. The role of percutaneous nephrolithotomy in the management of pediatric renal calculi. J Urol. 1997; 158 (3 Pt 2) 1319-1321
- 33 Musulmanogolu A Y, Tefekli A, Sarilar O, Binbay M, Altunrende F, Ozkuvanci U. Extracorporal Shock Wave Lithotripsy as First Line Treatment Alternative for Urinary Tract Stones in Children: A Large Scale Retrospective Analysis. J Urol. 2003; 170 2450-2408
- 34 Myers D A, Mobley T B, Jenkins J M, Grine W B, Jordan W R. Pediatric low energy lithotripsy with the Lithostar. J Urol. 1995; 153 453-457
- 35 Netto Jr N R, Claro J FA, Lemos G C, Contado P L. Treatment option for ureteral calculi: endourology or extracorporeal shock wave lithotripsy. J Urol. 1991; 146 5-7
- 36 Netto Jr N R, Longo J A, Ikonomidis J A, Rodrigues Netto M. ESWL in children. J Urol. 2002; 167 2164-2166
- 37 Nijman R J, Ackaert K, Scholtmeijer R J, Lock T W, Schroder F H. Long-term results of extracorporeal shock wave lithotripsy in children. J Urol. 1989; 142 (2 Pt 2) 609-611
- 38 Onal B, Demirkesen O, Tansu N, Kalkan M, Altintas R, Yalcin V. The impact of caliceal pelvic anatomy on stone clearance after shock wave. J Urol. 2004; 172 1082-1086
- 39 Orsola A, Diaz I, Caffaratti J, Izquierdo F, Alberola J, Garat J M. Staghorn calculi in children: treatment with monotherapy extracorporal shock wave lithotripsy. J Urol. 1999; 162 (3 Pt 2) 1229-1233
- 40 Ozgur Tan M, Karaoglan U, Sen I, Deniz N, Bozkirli I. The impact of radiological anatomy in clearance of lower calyceal stones after shock wave lithotripsy in pediatric patients. Eur Urol. 2003; 43 188-193
- 41 Pietrow P K, Pope 4th J C, Adams M C, Shyr Y, Brock 3rd J W. Clinical outcome of pediatric stone disease. J Urol. 2002; 167 (2 Pt 1) 670-673
- 42 Rizivi S A, Naqvi S A, Hussain Z, Hashimi A, Hussain M, Zafar M, Sulan S, Mehdi H. Management of Pediatric Urolithiasis in Pakistan: Experience With 1,440 Children. J Urol. 2003; 169 (2) 634-637
- 43 Shukla A R, Hoover D L, Homsy Y L, Perlman S, Schurman S, Reisman E M. Urolithiasis in the low birth weight infant: the role and efficacy of extracorporeal shock wave lithotripsy. J Urol. 2001; 165 (6 Pt 2) 2320-2323
- 44 Tan A H, Al-OMar M, Denstedt J D, Razvi H. Ureteroscopy for pediatric urolithiasis: An evolving first-line therapy. Urology. 2005; 65 (1) 153-156
- 45 Tan A H, Al-OMar M, Watterson J D, Nott L, Denstedt J D, Razvi H. Results of shockwave lithotripsy for pediatric urolithiasis. J Endourol. 2004; 18 (6) 527-530
- 46 Tiede J M, Lumpkin E N, Wass C T, Long T R. Hemoptysis following extracorporeal shock wave lithotripsy: a case of lithotripsy-induced pulmonary contusion in a pediatric patient. J Clin Anesth. 2003; 15 530-532
- 47 Van Savage J G, Palanca L G, Andersen R D, Rao G S, Slaughenhoupt B L. Treatment of distal ureteral stones in children: similarities to the American urological association guidelines in adults. J Urol. 2000; 164 (3 Pt 2) 1089-1093
- 48 Wollin T A, Teichman J M, Rogenes V J, Razvi H A, Denstedt J D, Grasso M. Holmium: YAG lithotripsy in children. J Urol. 1999; 152 1714-1716
- 49 Zeren S, Satar N, Bayazit Y, Bayazit A K, Payasli K, Ozkeceli R. Percutaneous nephrolithotomy in the management of pediatric renal calculi. J Endourol. 2002; 16 (2) 75-78
Dr. Moritz Hamann
Klinik für Urologie und Kinderurologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel
Arnold-Heller-Straße 7
24105 Kiel
Email: mhamann@urology.uni-kiel.de