He Tianqu,Zhao Yaowang.Current status and future prospects of prevention and treatment of pediatric urolithiasis[J].Journal of Clinical Pediatric Surgery,2025,(01):1-6.[doi:10.3760/cma.j.cn101785-202411028-001]
儿童尿石症的防治现状与展望
- Title:
- Current status and future prospects of prevention and treatment of pediatric urolithiasis
- Keywords:
- Urolithiasis; Disease Management; Surgical Procedures; Operative; Child
- 摘要:
- 近年来,儿童尿石症的发病率在全球范围内逐渐上升。体外冲击波碎石术、逆行肾内手术和经皮肾镜碎石术等微创技术已成为儿童尿石症的主要治疗方式。儿童(特别是婴幼儿)在解剖和生理上与成人存在显著差异,手术规划和管理时需特别考虑这些差异。预防儿童尿石症的关键措施包括合理的液体摄入、饮食管理、代谢评估和药物干预,且应根据个体化病因制定针对性的预防策略。未来,防治策略将更加依赖于个性化和精准化的手术干预及随访管理。小型化手术器械的应用、药物研发进展以及高质量研究的积累将有效推动儿童尿石症的防治进程。
- Abstract:
- In recent years,the incidence of pediatric urolithiasis has been increasing globally.Minimally invasive techniques,such as extracorporeal shock wave lithotripsy,retrograde intrarenal surgery,and percutaneous nephrolithotripsy,have become the mainstay of treatment for pediatric urolithiasis.Children,wspecially infants and toddlers,exhibit significant anatomical and physiologic differences from adults,which necessitate special considerations in surgical planning and management.Key measures for preventing pediatric urolithiasis include appropriate fluid intake,dietary management,metabolic evaluation,and pharmacological intervention,with targeted prevention strategies based on individualized etiologies.In the future,prevention and treatment strategies will increasingly rely on personalized and precise surgical interventions and follow-up management.Advances in miniaturized surgical instruments,pharmaceutical development,and the accumulation of high-quality research will effectively promote progress in the prevention and treatment of pediatric urolithiasis.
参考文献/References:
[1] Issler N, Dufek S, Kleta R, et al.Epidemiology of paediatric renal stone disease:a 22-year single centre experience in the UK[J]. BMC Nephrol, 2017, 18(1):136.DOI:10.1186/s12882-017-0505-x.
[2] Tasian GE, Kabarriti AE, Kalmus A, et al.Kidney stone recurrence among children and adolescents[J]. J Urol, 2017, 197(1):246-252.DOI:10.1016/j.juro.2016.07.090.
[3] Zeng GH, Zhu W, Somani B, et al.International Alliance of Urolithiasis (IAU) guidelines on the management of pediatric urolithiasis[J]. Urolithiasis, 2024, 52(1):124.DOI:10.1007/s00240-024-01621-z.
[4] 中华医学会泌尿外科学分会结石学组, 中国泌尿系结石联盟.儿童泌尿系结石诊疗中国专家共识[J]. 中华泌尿外科杂志, 2021, 42(2):81-88.DOI:10.3760/cma.j.cn112330-20210111-00017. Urolithiasis Group of Chinese Urological Association, China Alliance of Urolithiasis.Chinese expert consensus on diagnosis and management of paediatric urolithiasis[J]. Chin J Urol, 2021, 42(2):81-88.DOI:10.3760/cma.j.cn112330-20210111-00017.
[5] Tekgül S, Stein R, Bogaert G, et al.European Association of Urology and European Society for Paediatric Urology guidelines on paediatric urinary stone disease[J]. Eur Urol Focus, 2022, 8(3):833-839.DOI:10.1016/j.euf.2021.05.006.
[6] Bacchus MW, Locke RA, Kwenda EP, et al.Medical expulsive therapy (MET) for ureteral calculi in children:systematic review and meta-analysis[J]. Front Urol, 2022, 2:866162.DOI:10.3389/fruro.2022.866162.
[7] 中华医学会小儿外科学分会泌尿外科学组.儿童肾结石诊疗的临床专家共识[J]. 临床小儿外科杂志, 2021, 20(2):107-113.DOI:10.12260/lcxewkzz.2021.02.002. Group of Urology, Branch of Pediatric Surgery, Chinese Medical Association.Clinical expert consensus on managing kidney stones in children[J]. DOI:10.12260/lcxewkzz.2021.02.002.
[8] Güzel R, Yildirim V, Sarica K.Contemporary minimal invasive surgical management of stones in children[J]. Asian J Urol, 2023, 10(3):239-245.DOI:10.1016/j.ajur.2023.02.001.
[9] Dogan HS, Altan M, Citamak B, et al.A new nomogram for prediction of outcome of pediatric shock-wave lithotripsy[J]. J Pediatr Urol, 2015, 11(2):84.e1-84.e6.DOI:10.1016/j.jpurol.2015.01.004.
[10] Ba?uelos Marco B, Haid B, Radford A, et al.Guideline adherence of paediatric urolithiasis:an EAU members’ survey and expert panel roundtable discussion[J]. Children (Basel), 2022, 9(4):504.DOI:10.3390/children9040504.
[11] Geraghty RM, Jones P, Somani BK.Worldwide trends of urinary stone disease treatment over the last two decades:a systematic review[J]. J Endourol, 2017, 31(6):547-556.DOI:10.1089/end.2016.0895.
[12] Geraghty R, Lombardo R, Yuan C, et al.Outcomes of flexible ureteroscopy vs extracorporeal shock wave lithotripsy for renal stones in pediatric patients:a European Association of Urology urolithiasis guidelines systematic review and meta-analysis[J]. J Urol, 2023, 210(6):876-887.DOI:10.1097/JU.0000000000003696.
[13] Sen H, Baydilli N, Ozturk M, et al.Factors effecting the success of retrograde intrarenal surgery in pediatric patients with renal stones:the experience of two tertiary centres with 368 renal units[J]. J Pediatr Urol, 2024, 20(3):403.e1-403.e9.DOI:10.1016/j.jpurol.2024.01.004.
[14] Nouralizadeh A, Simforoosh N, Shemshaki H, et al.Tubeless versus standard percutaneous nephrolithotomy in pediatric patients:a systematic review and meta-analysis[J]. Urologia, 2018, 85(1):3-9.DOI:10.5301/uj.5000270.
[15] Cox RG, Ewen A, Bart BB.The prone position is associated with a decrease in respiratory system compliance in healthy anaesthetized infants[J]. Paediatr Anaesth, 2001, 11(3):291-296.DOI:10.1046/j.1460-9592.2001.00646.x.
[16] Ery?lmaz R, Ertas K, Aslan R, et al.Comparison of supine-prone percutaneous nephrolithotomy methods in the treatment of kidney stones in pediatric patients:prospective randomized study[J]. Urolithiasis, 2024, 52(1):73.DOI:10.1007/s00240-024-01543-w.
[17] Quiroz Y, Ferretti S, Campobasso D, et al.First worldwide multicentric series of mini-ECIRS in children:outcomes from two tertiary endourology centers[J]. J Endourol, 2024, 38(11):1141-1147.DOI:10.1089/end.2024.0168.
[18] Julieb?-Jones P, Pietropaolo A, Haugland JN, et al.Current status of ureteric stents on extraction strings and other non-cystoscopic removal methods in the paediatric setting:a systematic review on behalf of the European Association of Urology (EAU) Young Academic Urology (YAU) urolithiasis group[J]. Urology, 2022, 160:10-16.DOI:10.1016/j.urology.2021.11.022.
[19] Grabsky A, Tsaturyan A, Musheghyan L, et al.Effectiveness of ultrasound-guided shockwave lithotripsy and predictors of its success rate in pediatric population:a report from a national reference center[J]. J Pediatr Urol, 2021, 17(1):78.e1-78.e7.DOI:10.1016/j.jpurol.2020.10.014.
[20] Bortnick E, Kurtz MP, Cilento BG Jr, et al.Is cerebral palsy associated with successful ureteral access during the initial attempt at ureteroscopy for urolithiasis in children and young adults?[J]. J Pediatr Urol, 2023, 19(4):369.e1-369.e6.DOI:10.1016/j.jpurol.2023.04.014.
[21] McGee LM, Sack BS, Wan JL, et al.The effect of preoperative tamsulosin on ureteroscopic access in school-aged children[J]. J Pediatr Urol, 2021, 17(6):795.e1-795.e6.DOI:10.1016/j.jpurol.2021.08.021.
[22] Campbell P, Mudd B, Craig K, et al.One and done:feasibility and safety of primary ureteroscopy in a pediatric population[J]. J Pediatr Urol, 2024, 20(2):224.e1-224.e7.DOI:10.1016/j.jpurol.2023.10.031.
[23] De Coninck V, Keller EX, Rodríguez-Monsalve M, et al.Systematic review of ureteral access sheaths:facts and myths[J]. BJU Int, 2018, 122(6):959-969.DOI:10.1111/bju.14389.
[24] Julieb?-Jones P, Keller EX, Tzelves L, et al.Paediatric kidney stone surgery:state-of-the-art review[J]. Ther Adv Urol, 2023, 15:17562872231159541.DOI:10.1177/17562872231159541.
[25] Gauhar V, Madarriaga YQ, Somani B, et al.Is flexible and navigable suction ureteral access sheath (FANS-UAS) the next best development for retrograde intrarenal surgery in children? Results of a prospective multicentre study[J]. World J Urol, 2024, 42(1):627.DOI:10.1007/s00345-024-05337-y.
[26] Bhojani N, Koo KC, Bensaadi K, et al.Retrospective first-in-human use of the LithoVueTM Elite ureteroscope to measure intrarenal pressure[J]. BJU Int, 2023, 132(6):678-685.DOI:10.1111/bju.16173.
[27] 丛小明, 孙西钊.儿童泌尿系统结石的代谢评估[J]. 临床小儿外科杂志, 2020, 19(8):661-665.DOI:10.3969/j.issn.1671-6353.2020.08.001. Cong XM, Sun XZ.Metabolic evaluations of pediatric nephrolithiasis[J]. J Clin Ped Sur, 2020, 19(8):661-665.DOI:10.3969/j.issn.1671-6353.2020.08.001.
[28] Saadeh SA.Pediatric nephrolithiasis:risk factors, evaluation, and prevention[J]. Pediatr Ann, 2020, 49(6):e262-e267.DOI:10.3928/19382359-20200518-01.
[29] Carmen Tong CM, Ellison JS, Tasian GE.Pediatric stone disease:current trends and future directions[J]. Urol Clin North Am, 2023, 50(3):465-475.DOI:10.1016/j.ucl.2023.04.009.
[30] Rodriguez A, Saez-Torres C, Mir C, et al.Effect of sample time on urinary lithogenic risk indexes in healthy and stone-forming adults and children[J]. BMC Urol, 2018, 18(1):116.DOI:10.1186/s12894-018-0430-8.
[31] ?nal B, K?rl? EA.Pediatric stone disease:current management and future concepts[J]. Turk Arch Pediatr, 2021, 56(2):99-107.DOI:10.5152/TurkArchPediatr.2021.20273.
[32] Skolarikos A, Somani B, Neisius A, et al.Metabolic evaluation and recurrence prevention for urinary stone patients:an EAU guidelines update[J]. Eur Urol, 2024, 86(4):343-363.DOI:10.1016/j.eururo.2024.05.029.
[33] 赵夭望, 李创业.儿童遗传性肾结石的治疗进展[J]. 临床小儿外科杂志, 2020, 19(8):666-671.DOI:10.3969/j.issn.1671-6353.2020.08.002. Zhao YW, Li CY.Recent advances in the treatment of hereditary nephrolithiasis in children[J]. J Clin Ped Sur, 2020, 19(8):666-671.DOI:10.3969/j.issn.1671-6353.2020.08.002.
[34] Chen ZT, Zhang DX, Zheng R, et al.In vivo base editing rescues primary hyperoxaluria type 1 in rats[J]. Kidney Int, 2024, 105(3):496-507.DOI:10.1016/j.kint.2023.11.029.
[35] Wang Z, Liu L, Zhao YW, et al.Carboxymethylated Desmodium styracifolium polysaccharide reduces the risk of calcium oxalate kidney stone formation by inhibiting crystal adhesion and promoting crystal endocytosis[J]. J Cell Physiol, 2024, 239(6):e31272.DOI:10.1002/jcp.31272.
[36] Ellison JS, Lorenzo M, Beck H, et al.Comparative effectiveness of paediatric kidney stone surgery (the PKIDS trial):study protocol for a patient-centred pragmatic clinical trial[J]. BMJ Open, 2022, 12(4):e056789.DOI:10.1136/bmjopen-2021-056789.
[37] Julieb?-Jones P, Ulvik ?, Beisland C, et al.Paediatric percutaneous nephrolithotomy (P-PCNL) reporting checklist[J]. Scand J Urol, 2023, 58:115-119.DOI:10.2340/sju.v58.13392.
[38] Julieb?-Jones P, Ulvik ?, Beisland C, et al.Paediatric Ureteroscopy (P-URS) reporting checklist:a new tool to aid studies report the essential items on paediatric ureteroscopy for stone disease[J]. Urolithiasis, 2023, 51(1):35.DOI:10.1007/s00240-023-01408-8.
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备注/Memo
收稿日期:2024-11-13。
基金项目:湖南省儿童泌尿生殖疾病临床医学研究中心(2021SK4017);湖南省卫生健康委科研计划项目(B202304057979)
通讯作者:赵夭望,Email:yw508@sina.com