The role of surgery and lithotripsy in childhood urolithiasis.

From 1982 through 1993 36 interventions in 32 infants and children with urolithiasis have been performed in our department. There were 22 boys and 10 girls. The main cause for the interventions have been congenital malformations in 9, followed by recurrent urinary tract infections in 6, previous operations in 5 and hypercalciuria in 5 patients. In 7 children the cause of the urolithiasis remained unknown. As a therapeutic option extracorporeal shock-wave lithotripsy (ESWL) was available after 1988. The malformations as well as the postoperative conditions have been corrected surgically and the calculi were removed at the same time. For post-infectious, idiopathic or hypercalciuric calculi ESWL was used in the majority of patients after 1988. Therefore a total of 26 calculi were removed by operation and 13 by ESWL. Only 1 calculus was extracted endoscopically. There were no complications either after ESWL or after open surgery. Our results show that ESWL gains more and more importance in infants and children. Calculi in congenital malformations or as result of operations are still removed by open surgery. In the other cases ESWL is the method of choice.