Skip to main content

Advertisement

SpringerLink
Log in

Review Summary of Recent “High-Level” Evidence on the Management of Pediatric Urinary Stones

  • Surgery
  • Published:
SN Comprehensive Clinical Medicine Aims and scope Submit manuscript

Abstract

The objective of this study is to summarize literature from the past 10 years on pediatric stone management with a focus on evidence generated from meta-analysis, systematic reviews, and randomized controlled trials (RCTs). Systematic literature search was performed on May 26, 2020. The search was on publications from the past 10 years and limited to meta-analysis, systematic reviews, and relevant RCTs on pediatric urolithiasis. Summary of literature was clustered to stone etiology, diagnostics, medical management, and surgical management. Summary of evidence was extracted with GRADE criteria used to standardize the level and quality of evidence reported. A total of 32 articles (19 systematic reviews with meta-analysis, 4 systematic reviews, and 9 relevant RCTs) were included. We summarized the genetic association with pediatric stone formation, diagnostics, medical management such as dissolution and medical expulsion therapy, procedural efficacy, as well as safety for extracorporeal lithotripsy, retrograde intrarenal surgery, and percutaneous nephrolithotomy. We also evaluated each article’s approach to the comparison of outcome measures. Most of the available evidence was determined to be “very low” to “low” quality. Heterogeneity and low precision of the included studies led to downgrading using GRADE criteria. Relevant RCTs qualified as “high” to “uncertain” risk of bias in several domains of the study implementation and analysis. In the past decade, several systematic reviews, meta-analysis, and relevant RCTs that were mostly “very low” to “low” quality of evidence are available, and no definitive recommendations can be given to guide a pediatric urologist. We strongly recommend an individualized approach in the management of pediatric urolithiasis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Data Availability and Material

Not applicable.

Code Availability

Not applicable.

References

  1. Barreto L, Jung JH, Abdelrahim A, Ahmed M, Dawkins GPC, Kazmierski M. Reprint - Medical and surgical interventions for the treatment of urinary stones in children: a Cochrane review. Can Urol Assoc J. 2019;13(10):334–41. https://doi.org/10.5489/cuaj.5787.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Taguchi K, Cho SY, Ng AC, et al. The Urological Association of Asia clinical guideline for urinary stone disease. Int J Urol. 2019;26(7):688–709. https://doi.org/10.1111/iju.13957.

    Article  PubMed  Google Scholar 

  3. Radmayr C, Bogaert G, Dogan HS, Kočvara R, Nijman JM, Stein R, Tekgul S, Undre S. EAU guidelines on paediatric urology. In EAU Guidelines, edition presented at the annual EAU Congress Barcelona 2019. Radmayr C, Bogaert G, Dogan HS, Kočvara R, Nijman JM, Stein R, Tekgul S, Undre S. EAU guidelines on paediatric urology. InEAU Guidelines, edition presented at the annual EAU Congress Barcelona 2019.

  4. Balshem H, Helfand M, Schunemann HJ, Oxman AD, Kunz R, Brozek J, et al. GRADE guidelines: 3. Rating the quality of evidence. Journal of Clinical Epidemiology. 2011;64(4):401–6.

    Article  Google Scholar 

  5. Taguchi K, Yasui T, Milliner DS, Hoppe B, Chi T. Genetic risk factors for idiopathic urolithiasis: a systematic review of the literature and causal network analysis. Eur Urol Focus. 2017;3(1):72pe B, Chi T. Genetic ozek J, et al.

    Article  Google Scholar 

  6. González-Castro TB, Blachman-Braun R, Hernández-Díaz Y, Tovilla-Zárate CA, Pérez-Hernández N, Moscardi PRM, et al. Association of vitamin D receptor polymorphisms and nephrolithiasis: a meta-analysis. Gene. 2019;711:143936. https://doi.org/10.1016/j.gene.2019.06.026.

    Article  CAS  PubMed  Google Scholar 

  7. Rendina D, De Filippo G, D’Elia L, Strazzullo P. Metabolic syndrome and nephrolithiasis: a systematic review and meta-analysis of the scientific evidence. J Nephrol. 2014;27(4):371–6. https://doi.org/10.1007/s40620-014-0085-9.

    Article  CAS  PubMed  Google Scholar 

  8. Laher AE, McDowall J, Gerber L, Aigbodion SJ, Enyuma COA, Buchanan S, et al. The ultrasound ‘twinkling artefact’ in the diagnosis of urolithiasis: hocus or valuable point-of-care-ultrasound? A systematic review and meta-analysis. Eur J Emerg Med. 2020;27(1):13–20. https://doi.org/10.1097/MEJ.0000000000000601.

    Article  PubMed  Google Scholar 

  9. Fazel M, Gubari MIM, Yousefifard M, Hosseini M. Ultrasonography in detection of renal calculi in children; a systematic review and meta-analysis. Arch Acad Emerg Med. 2019;7(1):e66.

    PubMed  PubMed Central  Google Scholar 

  10. Barreto L, Jung JH, Abdelrahim A, Ahmed M, Dawkins GPC, Kazmierski M. Medical and surgical interventions for the treatment of urinary stones in children [published online ahead of print, 2019 Oct 9]. Cochrane Database Syst Rev. 2019;10(10):CD010784. https://doi.org/10.1002/14651858.CD010784.pub3.

    Article  PubMed  Google Scholar 

  11. Tian D, Li N, Huang W, Zong H, Zhang Y. The efficacy and safety of adrenergic alpha-antagonists in treatment of distal ureteral stones in pediatric patients: a systematic review and meta-analysis. J Pediatr Surg. 2017;52(2):360–5. https://doi.org/10.1016/j.jpedsurg.2016.10.003.

    Article  PubMed  Google Scholar 

  12. Pickard R, Starr K, MacLennan G, Lam T, Thomas R, Burr J, et al. Medical expulsive therapy in adults with ureteric colic: a multicentre, randomised, placebo-controlled trial. Lancet. 2015;386(9991):341–9. https://doi.org/10.1016/S0140-6736(15)60933-3.

    Article  PubMed  Google Scholar 

  13. Sridharan K, Sivaramakrishnan G. Efficacy and safety of alpha blockers in medical expulsive therapy for ureteral stones: a mixed treatment network meta-analysis and trial sequential analysis of randomized controlled clinical trials. Expert Rev Clin Pharmacol. 2018;11(3):291–307. https://doi.org/10.1080/17512433.2018.1424537.

    Article  CAS  PubMed  Google Scholar 

  14. Sridharan K, Sivaramakrishnan G. Medical expulsive therapy in urolithiasis: a mixed treatment comparison network meta-analysis of randomized controlled clinical trials. Expert Opin Pharmacother. 2017;18(14):1421–31. https://doi.org/10.1080/14656566.2017.1362393.

    Article  PubMed  Google Scholar 

  15. Elderwy AA, Kurkar A, Hussein A, Abozeid H, Hammodda HM, Ibraheim AF. Dissolution therapy versus shock wave lithotripsy for radiolucent renal stones in children: a prospective study. J Urol. 2014;191(5 Suppl):1491–5. https://doi.org/10.1016/j.juro.2013.10.060.

    Article  PubMed  Google Scholar 

  16. Shahat A, Elderwy A, Safwat AS, et al. Is tamsulosin effective after shock wave lithotripsy for pediatric renal stones? A randomized, controlled study. J Urol. 2016;195(4 Pt 2):1284 al. Is Is ammodda HM, Ibraheim AF. D.

    Article  CAS  Google Scholar 

  17. Kern A, Grimsby G, Mayo H, Baker LA. Medical and dietary interventions for preventing recurrent urinary stones in children. Cochrane Database Syst Rev. 2017;11(11):CD011252. Published 2017 Nov 9. https://doi.org/10.1002/14651858.CD011252.pub2.

    Article  PubMed  Google Scholar 

  18. Milliner D, Hoppe B, Groothoff J. A randomised Phase II/III study to evaluate the efficacy and safety of orally administered Oxalobacter formigenes to treat primary hyperoxaluria. Urolithiasis. 2018;46(4):313–23. https://doi.org/10.1007/s00240-017-0998-6.

    Article  CAS  PubMed  Google Scholar 

  19. Lu P, Wang Z, Song R, et al. The clinical efficacy of extracorporeal shock wave lithotripsy in pediatric urolithiasis: a systematic review and meta-analysis. Urolithiasis. 2015;43(3):199199sis 2018;46(4/s00240-015-0757-5.

    Article  Google Scholar 

  20. AbdelRazek M, Hassan A, AbdelKader MS, Abolyosr A. SWL outcome in artificial hydronephrotic vs non-hydronephrotic kidney for preschool children with high-density renal stones. World J Urol. 2019;37(5):937–41. https://doi.org/10.1007/s00345-018-2471-8.

    Article  PubMed  Google Scholar 

  21. Salem HK, Fathy H, Elfayoumy H, et al. Slow vs rapid delivery rate shock wave lithotripsy for pediatric renal urolithiasis: a prospective randomized study. J Urol. 2014;191(5):1370370 Urol. 2019;37(5):937-941. doi:10.

    Article  Google Scholar 

  22. Whatley A, Jones P, Aboumarzouk O, Somani BK. Safety and efficacy of ureteroscopy and stone fragmentation for pediatric renal stones: a systematic review. Transl Androl Urol. 2019;8(Suppl 4):S442–7. https://doi.org/10.21037/tau.2019.08.23.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Rob S, Jones P, Pietropaolo A, Griffin S, Somani BK. Ureteroscopy for stone disease in paediatric population is safe and effective in medium-volume and high-volume centres: evidence from a systematic review. Curr Urol Rep. 2017;18(12):92. Published 2017 Oct 18. https://doi.org/10.1007/s11934-017-0742-3.

    Article  PubMed  PubMed Central  Google Scholar 

  24. De Coninck V, Keller EX, Rodrodr:92. Published 2017 Oct 18. doi:10.1007/s11934-017-0742-3ne fragmentation for pediatric renal stones: a systematic review. Transl Androl Urol. 2019;8(Suppl 4):

  25. Fahmy A, Youssif M, Rhashad H, Orabi S, Mokless I. Extractable fragment versus dusting during ureteroscopic laser lithotripsy in children: prospective randomized study. J Pediatr Urol. 2016;12(4):254.e1 e fragment versus dusting during ureteroscop.

    Article  Google Scholar 

  26. Kokorowski PJ, Chow JS, Cilento BG Jr, et al. The effect of surgeon versus technologist control of fluoroscopy on radiation exposure during pediatric ureteroscopy: a randomized trial. J Pediatr Urol. 2018;14(4):334.e1 ffect of surgeon versus technologis04.035.

    Article  Google Scholar 

  27. Jones P, Bennett G, Aboumarzouk OM, Griffin S, Somani BK. Role of minimally invasive percutaneous nephrolithotomy techniques-micro and ultra-mini PCNL (<15F) in the pediatric population: a systematic review. J Endourol. 2017;31(9):816 OM, Griffin S, Somend.2017.0136.

    Article  Google Scholar 

  28. Nouralizadeh A, Simforoosh N, Shemshaki H, Soltani MH, Sotoudeh M, Ramezani MH, et al. Tubeless versus standard percutaneous nephrolithotomy in pediatric patients: a systematic review and meta-analysis. Urologia. 2018;85(1):3–9. https://doi.org/10.5301/uj.5000270.

    Article  PubMed  Google Scholar 

  29. He Q, Xiao K, Chen Y, Liao B, Li H, Wang K. Which is the best treatment of pediatric upper urinary tract stones among extracorporeal shockwave lithotripsy, percutaneous nephrolithotomy and retrograde intrarenal surgery: a systematic review. BMC Urol. 2019;19(1):98. Published 2019 Oct 23. https://doi.org/10.1186/s12894-019-0520-2.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Basiri A, Zare S, Tabibi A, et al. A multicenter, randomized, controlled trial of transureteral and shock wave lithotripsy—which is the best minimally invasive modality to treat distal ureteral calculi in children? J Urol. 2010;184(3):1106n children? https://doi.org/10.1016/j.juro.2010.05.021.

    Article  PubMed  Google Scholar 

  31. Farouk A, Tawfick A, Shoeb M, Mahmoud MA, Mostafa DE, Hasan M, et al. Is mini-percutaneous nephrolithotomy a safe alternative to extracorporeal shockwave lithotripsy in pediatric age group in borderline stones? A randomized prospective study. World J Urol. 2018;36(7):1139–47. https://doi.org/10.1007/s00345-018-2231-9.

    Article  PubMed  Google Scholar 

  32. Donaldson JF, Ruhayel Y, Skolarikos A, MacLennan S, Yuan Y, Shepherd R, et al. Treatment of bladder stones in adults and children: a systematic review and meta-analysis on behalf of the European Association of Urology Urolithiasis Guideline Panel. Eur Urol. 2019;76(3):352–67. https://doi.org/10.1016/j.eururo.2019.06.018.

    Article  PubMed  Google Scholar 

  33. Welk B, Afshar K, MacNeily AE. Randomized controlled trials in pediatric urology: room for improvement. J Urol. 2006;176(1):30630606 018pediatric age group in borderl.

    Article  Google Scholar 

  34. Radmayr C, Tekgul S. Paediatric urology and the dilemma of low-quality evidence for the management of common urological conditions (vesicoureteral reflux, lower urinary tract dysfunction, undescended testis) in children. Eur Urol Focus. 2017;3(2-3):308–9. https://doi.org/10.1016/j.euf.2017.03.012.

    Article  PubMed  Google Scholar 

  35. Bai Y, Tang Y, Deng L, et al. Management of large renal stones: laparoscopic pyelolithotomy versus percutaneous nephrolithotomy. BMC Urol. 2017;17(1):75. Published 2017 Aug 31. https://doi.org/10.1186/s12894-017-0266-7.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Ming JM, Harvey EH, Bagli DJ, Lopes RI, Saunders MA, Farhat WA, et al. Cost-effectiveness of a multidisciplinary stone clinic in a tertiary care children’s hospital. 2016 NS-AUA Abstracts. CUAJ. 2016;10(9-10Suppl 4):S171.

    Google Scholar 

  37. Lee AS, McGarry L, Bowen DK, Tasian GE. Patient characteristics associated with completion of 24-h urine analyses among children and adolescents with nephrolithiasis. Urology. 2019;127:102GE Patient MA, Farhat WA, Dos Santos.

    Article  Google Scholar 

  38. Rodriguez Cuellar CI, Wang PZT, Freundlich M, Filler G. Educational review: role of the pediatric nephrologists in the work-up and management of kidney stones. Pediatr Nephrol. 2020;35(3):383–97. https://doi.org/10.1007/s00467-018-4179-9.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Urology, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, Canada

    Michael E. Chua, Keara N. De Cotiis & Joana Dos Santos

  2. Department of Surgery, University of Toronto, Toronto, Canada

    Michael E. Chua, Keara N. De Cotiis, Justin Jin Kyu Kim & Joana Dos Santos

  3. Institute of Urology, St. Luke’s Medical Center, Quezon City, Philippines

    Michael E. Chua

  4. Department of Urology, University of New Mexico, Albuquerque, NM, USA

    Jessica M. Ming

  5. Department of Urology, Taipei Tzu Chi Hospital and Buddhist Tzu Chi University, New Taipei, Taiwan

    Stephen S. Yang

  6. Department of Urology, University of Wisconsin, Madison, WI, USA

    Walid A. Farhat

Authors
  1. Michael E. Chua
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jessica M. Ming
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Keara N. De Cotiis
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Justin Jin Kyu Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Stephen S. Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Walid A. Farhat
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Joana Dos Santos
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Conception and design: Michael E Chua, Jessica M Ming, Keara N De Cotiis, Justin Jin Kyu Kim, Stephen Yang, Joana Dos Santos.

Data acquisition: Michael E Chua, Jessica M Ming, Justin Jin Kyu Kim.

Data analysis and interpretation: Michael E Chua, Jessica M Ming, Keara N De Cotiis, Justin Jin Kyu Kim, Walid Farhat.

Drafting the manuscript: Michael E Chua, Jessica M Ming, Keara N De Cotiis, Justin Jin Kyu Kim, Stephen Yang, Joana Dos Santos.

Critical revision of the manuscript for scientific and factual content: Michael E Chua, Jessica M Ming, Keara N De Cotiis, Stephen Yang, Walid Farhat.

Statistical analysis: Michael E Chua, Justin Jin Kyu Kim.

Supervision: Stephen Yang, Joana Dos Santos, Walid Farhat.

Corresponding author

Correspondence to Michael E. Chua.

Ethics declarations

Ethics Approval

Not applicable.

Consent to Participate

Not applicable.

Consent for Publication

Not applicable.

Conflict of Interest

The authors declare no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Surgery

Supplementary Information

ESM 1

(DOCX 14 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chua, .E., Ming, J.M., De Cotiis, K.N. et al. Review Summary of Recent “High-Level” Evidence on the Management of Pediatric Urinary Stones. SN Compr. Clin. Med. 3, 2301–2311 (2021). https://doi.org/10.1007/s42399-021-01016-w

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s42399-021-01016-w

Keywords

Search

Navigation