Division of Pediatric Urology, Aboul-Riche Children's Hospital, Cairo University, Cairo, Egypt.
J Pediatr Urol. 2013 Dec;9(6 Pt B):1178-82. doi: 10.1016/j.jpurol.2013.05.003. Epub 2013 Jun 12.
Urolithiasis in infants can cause considerable morbidity. The literature regarding calcular anuria in this age group is very defective. Our aim was to evaluate impact of intervention on renal recoverability in these infants.
A series of 24 patients presenting with obstructive calcular anuria were included in this study. Mean age was 16.5 ± 6.2 months. They were treated either by initial urinary diversion or definitive endoscopic (ureteroscopy or JJ stenting with medical alkalinization) or open surgical (ureterolithotomy or pyelolithotomy) treatment.
Mean serum creatinine was 5.8 ± 2.6 mg/dl. Initial peritoneal dialysis and/or urinary diversion was needed in 11 patients (45.8%). Open surgical treatment was applied in 5 (20.8%), endoscopic treatment was applied in 15 (62.5%), while combined treatment was applied in 4 (16.6%) patients. All patients had normal serum creatinine on discharge. Three (12.5%) had residual stones which were cleared by 2ry ureteroscopic intervention at 6 months. The overall complication rate in this study was 12.5% in the form of postoperative leakage (1) and postoperative fever (2). No mortality or development of chronic renal failure was reported at 6 months follow up. In comparison with these results, a previous study carried out in our centre on an older age group had a higher complication rate (28%) with higher mortalities and lower renal function recoverability rate (94%).
Appropriate and timely medical and surgical management of calcular anuria will mostly lead to full recovery of renal functions. In comparison with older children, renal prognosis in those less than 2 years seems more favorable.
婴儿尿路结石可导致相当大的发病率。关于该年龄段结石性无尿的文献非常不完善。我们的目的是评估干预措施对这些婴儿肾脏恢复能力的影响。
本研究纳入了 24 例有梗阻性结石性无尿的患者。平均年龄为 16.5±6.2 个月。他们接受了初始尿路引流或确定性内镜（输尿管镜检查或 JJ 支架置入联合药物碱化）或开放手术（输尿管切开取石术或肾盂切开取石术）治疗。
平均血清肌酐为 5.8±2.6mg/dl。11 例（45.8%）患者需要初始腹膜透析和/或尿路引流。5 例（20.8%）患者接受了开放手术治疗，15 例（62.5%）患者接受了内镜治疗，4 例（16.6%）患者接受了联合治疗。所有患者出院时血清肌酐均正常。3 例（12.5%）患者有残余结石，在 6 个月时通过二次输尿管镜干预清除。本研究的总并发症发生率为 12.5%，表现为术后漏尿（1 例）和术后发热（2 例）。在 6 个月的随访中，没有死亡或慢性肾衰竭的发生。与这些结果相比，我们中心以前对年龄较大的患者进行的一项研究，并发症发生率更高（28%），死亡率更高，肾功能恢复率更低（94%）。
对结石性无尿进行适当和及时的内科和外科治疗，大多数情况下可使肾功能完全恢复。与年龄较大的儿童相比，2 岁以下儿童的肾脏预后似乎更有利。
