Calculi

Children with urinary tract calculi present for evaluation with similar signs and symptoms as do their adult counterparts. It was previously thought that pediatric urolithiasis was unique and distinct from adult urolithiasis; however, it has become clear that the two entities share many basic characteristics. One important dis-

Pediatric Renal Trauma

U/A >50 RBC/HPF Deceleration injury

Stable

Renal exploration

Unstable

Abdominal exploration

U/A <50 RBC/HPF Stable No associated injuries

Observe

Penetrating

Unstable

Stable

Abdominal exploration

Explore

Fig. 8.21. Pediatric renal trauma algorithm adapted from Buckley and McAninch 2004. U/A urinalysis; RBC/HPF red blood cells per high power field

Observe

Observe

Normal

Abnormal

Observe

Fig. 8.22. Plain film radiograph of a 12-year-old male cystinuric patient with a history of gross hematuria and intermittent right flank pain
Fig. 8.23. Plain film radiograph demonstrating large, bilateral renal pelvic calculi. This patient successfully underwent staged bilateral ESWL

tinction between the two is that children are much more likely to harbor some underlying metabolic or enzymatic defect as the etiology for their stone disease (Milliner and Murphy 1993) (Fig. 8.22). Therefore, all children who present with urinary calculi require a complete metabolic evaluation following the resolution and treatment of the acute stone episode. The surgical treatment of pediatric urolithiasis consists of the same endourological practices and techniques that originated in adults. ESWL is very effective for even larger in-trarenal and proximal ureteral calculi (Pearle 2003) (Fig. 8.23). With advancements in technology and miniaturization of endoscopes, when indicated, virtually every child can undergo ureteroscopic evaluation and intracorporeal laser lithotripsy (Tan et al. 2005).

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