Telli Onur, Hamidi Nurullah, Bagci Uygar, Demirbas Arif, Hascicek Ahmet Metin, Soygur Tarkan, Burgu Berk
Department of Pediatric Urology, School of Medicine, Ankara University, Sihhiye, Ankara, 06100, Turkey.
Department of Urology, School of Medicine, Ankara University, Ankara, Turkey.
Pediatr Nephrol. 2017 May;32(5):853-857. doi: 10.1007/s00467-016-3570-7. Epub 2017 Jan 9.
The optimal management of lower pole kidney (LPK) stones in children is controversial. The aim of this study was to determine the outcomes of children with asymptomatic isolated LPK stones smaller than 10 mm during follow-up.
A total of 242 patients with 284 stones presenting at our institution between June 2004 and December 2014 with an asymptomatic, single LPK stone with a diameter of <10 mm were enrolled in the study. All children were assigned to receive first-line therapy and then categorized according to the need for medical intervention. Age, gender, stone laterality, stone size and type, associated urinary tract problems, and uncontrolled metabolic status were assessed as predictive factors of medical treatment for small (<10 mm) asymptomatic LPK stones. Stone-free rates were compared between interventions.
The mean age and mean stone size were 9.4 ± 1.9 years and 7.4 ± 0.6 mm at admission, respectively. Stone progression rate was 61.2%, and the mean time for intervention was 19.2 ± 4.6 months. Flexible ureterorenoscopy (n = 68) or micro-percutaneous nephrolithotomy (n = 4) were performed for 72 stones (25.4%; group 1), and extracorporeal shock wave lithotripsy was performed for 102 stones (35.9%; group 2). The stone-free rates were 81.8 and 79.3% in group 1 and 2, respectively (p > 0.05). The remaining asymptomatic stones (110, 38.8%; group 3) were managed by continued observation, and at the end of the observation time (mean 40.8 ± 20.8 months) the spontaneous passage rate was 9.1% in this group. In the multivariate analysis, stone size of >7 mm, concurrent renal anomalies, and stones composed of magnesium ammonium phosphate (struvite) and cystine were statistically significant predictors of the need for intervention.
Children with stones larger than 7 mm, renal anomalies, or stones composed of metabolically active cystine or struvite are more likely to require intervention, and those with asymptomatic LPK stones smaller than 10 mm can be managed by continued observation.
儿童下极肾（LPK）结石的最佳治疗方法存在争议。本研究的目的是确定随访期间无症状孤立性LPK结石小于10毫米的儿童的治疗结果。
2004年6月至2014年12月期间，共有242例患者携带284颗结石到我院就诊，纳入研究的患者均为无症状的单个LPK结石，直径<10毫米。所有儿童均接受一线治疗，然后根据是否需要医学干预进行分类。评估年龄、性别、结石位置、结石大小和类型、相关泌尿系统问题以及未控制的代谢状况，作为小（<10毫米）无症状LPK结石医学治疗的预测因素。比较不同干预措施后的无结石率。
入院时的平均年龄和平均结石大小分别为9.4±1.9岁和7.4±0.6毫米。结石进展率为61.2%，平均干预时间为19.2±4.6个月。对72颗结石（25.4%；第1组）进行了输尿管软镜检查（n = 68）或微通道经皮肾镜取石术（n = 4），对102颗结石（35.9%；第2组）进行了体外冲击波碎石术。第1组和第2组的无结石率分别为81.8%和79.3%（p>0.05）。其余无症状结石（110颗，38.8%；第3组）通过持续观察进行处理，在观察期结束时（平均40.8±20.8个月），该组的自然排石率为9.1%。在多变量分析中，结石大小>7毫米、并发肾脏异常以及由磷酸镁铵（鸟粪石）和胱氨酸组成的结石是干预必要性的统计学显著预测因素。
结石大于7毫米、有肾脏异常或由代谢活跃的胱氨酸或鸟粪石组成的结石的儿童更有可能需要干预，而无症状LPK结石小于10毫米的儿童可以通过持续观察进行处理。
