Analysis Of Clinical Characteristics And Evaluation Of Minimally Invasive Therapy Of Urinary Calculi In Children

Chapter 1.Epidemiology and etiological characteristics of urinary calculi in childrenOver the past decades,the incidence of urinary calculi in children increased worldwide,and the type of calculi also changed.Kidney stones containing calcium oxalate or calcium phosphate increased whereas bladder stones composed of ammonium and uric acid decreased.There is obvious regional difference in the incidence of stones,which leads to the introduction of "stone belt".Family history and genetic susceptibility increase the risk of individual urinary calculi.Adequate drinking water and a balanced diet are very important to reduce the risk of urinary calculi.In addition,climate conditions also play an important role in the pathogenesis of calculi.The incidence of urinary calculi increases in warm and sunny areas.Chapter 2.Meta-analysis of clinical characteristics of urinary calculi in childrenObjective Urinary calculi in children is an important medical condition,and its incidence has been increasing worldwide.The main objective of this study was to investigate the clinical characteristics and the most important risk factors of urinary calculi in children.Methods Using Cochrane Library,PubMed,ProQuest,ELEVIER Science Direct,Embase,Springerlink,CNKI,and Wanfang database,we searched the literature on clinical characteristics of urinary calculi in children from January 2003 to September 2018 and analyzed data using STATA 14.0.Results The ratio of urinary calculi in male children was62.1% [ 95%CI(57.2%,67.1%)].For children with urolithiasis,39.4% [95% CI(26.5%,52.2%)] had positive family history of calculi,25.3% [95% CI(19.2%,31.3%)] had a history of urinary tract infection,and16.6%[95% CI(12.3%,20.9%)] had abnormal urinary anatomy.The most common urinary calculi in children was found in kidney 63.6%[ 95% CI(49.9%,77.3%)],followed by ureter 17.2%[ 95%CI(13.4%,21.0%)]and bladder 12.4%[ 95% CI(6.9%,18.7%)].Moreover,approximately 67.6% of urinary calculi in children had a single component.Of these,calcium oxalate 49.4%[ 95% CI(36.7%,62.1%)] was the most common component,followed by uric acid 7.9%[95% CI(4.1%,11.6%)].Finally,the most common urinary metabolic abnormalities were hypernatremia 38.8%[ 95% CI(27.9%,49.7%)],followed by hypercalciuria 33.4%[ 95% CI(27.3%,39.4%)].Conclusion Metabolic abnormality,anatomical structure abnormality,and heredity factors are risk factors of urinary calculi in children.Properly controlling urinary tract infection,correcting anatomical abnormality,and regulating metabolic disorders may achieve treatment and avoid stone recurrence.Chapter 3.Systematic review of minimally invasive percutaneous nephrolithotomy versus retrograde intrarenal surgery for pediatric patients with renal stonesObjective The objective of this study is to compare the efficacy and safety of the percutaneous nephrolithotomy(PCNL)and retrograde intrarenal surgery(RIRS)in surgical treatment of pediatric patients with renal stones based on the published literature.Methods A comprehensive literature search of Cochrane Library,Pubmed,ProQuest,ELEVIER ScienceDirect,Embase,SpringerLink,China Knowledge Resource Integrated Database(CNKI),and Wanfang database was conducted to identify studies comparing outcomes of PCNL and RIRS for treating pediatric patients with renal stones before August 2018.RevMan 5.3 and Stata 14.0 software were used for statistical analysis after literature was screened according to inclusion and exclusion criteria.Data were extracted and the quality of included studies was evaluated.Results A total of 9 studies,containing 848 children with renal stones were included in a meta-analysis.The initial stone-free rate(SFR)in the PCNL group were significantly higher compared to the RIRS group [ OR = 1.74,95% CI(1.25,2.43)].However,PCNL required significantly longer fluoroscopy time [WMD = 72.99 sec,95% CI(57.06 sec,88.92 sec)],and hospital stay [WMD = 1.40 day,95% CI(0.61 days,2.20 days)] than RIRS(all P values < 0.05).Analysis of consequence for complications showed that the incidence of urinary tract infection was higher for RIRS compared to PCNL [OR=0.27,95% CI(0.357,0.587),P = 0.02].The rate of blood transfusion,however,was lower for RIRS than PCNL [OR = 3.68,95% CI(1.29,10.48),P = 0.01].No significant differences were found in operative time,final stone-free rates,postoperative fever,and overall complications.Conclusion PCNL achieves higher SFR after a single session in treating pediatric renal stones.However,RIRS has some advantages over PCNL such as shorter hospitalization time and fluoroscopy time.