Urolithiasis in the pediatric population - current opinion on epidemiology, patophysiology, diagnostic evaluation and treatment.

Urolithiasis, a condition in which calculi are found in the urinary tract, has been known for centuries. Although the disease was considered casuistic in the pediatric population, its prevalence is rising among both children and infants. The occurrence of the disease is greater in developed countries, therefore urolithiasis should be considered a lifestyle disease. Its etiopathogenesis has not yet been well understood. Kidney stone formation is influenced by factors such as climate, eating habits, profession, fluid intake, genetic predisposition, urinary tract infections and malformations of the urinary tract. Calculi are usually composed of mixed mineral substances. Only about 30% are made up of one chemical substance, calcium oxalate being the most common. Urolithiasis can be asymptomatic and accidentally diagnosed. Abdominal pain is the most common clinical symptom, however disease presentation among infants is nonspecific. Hematuria is a common clinical finding. Ultrasonography is the most important diagnostic tool in the diagnosis of kidney stone disease. Metabolic evaluation is required in every case of urolithiasis in the pediatric population, as metabolic disorders can be found in the majority of cases in this age group. The spontaneous passage of calculi less than 6mm in diameter is likely. Invasive treatment should be carried out if stones exceed 6mm in diameter or fail to expulse spontaneously. Prophylactic treatment includes adequate fluid intake, healthy eating habits and physical activity to maintain a healthy weight. Urolithiasis is a recurrent disease, therefore long-term treatment, prophylaxis and a lasting change in dietary habits are essential.

Early complications of extracorporeal shockwave lithotripsy in the records of the Department of Paediatrics, Nephrology and Allergology of the Military Institute of Medicine - preliminary results.

The aim of the study was to analyse the frequency and type of early complications of extracorporeal shock wave lithotripsy (ESWL) and to assess the safety of the procedure among paediatric patients. The study is a retrospective analysis of all ESWL procedures carried out due to urolithiasis in 2009-2015 in the Department of Paediatrics, Nephrology and Allergology of the Military Institute of Medicine. Medical records of 170 children were analysed: 94 girls (55.3%) and 76 boys (44.7%) aged 1 to 18 years. Out of the 272 procedures performed, 247 were included in the study. Among 233 effective ESWL treatments, complications were noted in 35 (15.02%) procedures: among 10 girls (40%) and 15 boys (60%). In 25 cases (10.73%) surgical intervention was necessary due to urinary obstruction caused by a fragment of a disintegrated stone. Urinary tract infection was present among 3 patients (1.29%) who required surgical treatment. Nonsurgical complications included 7 urinary tract infections (3%) and 3 cases of severe abdominal pain (1.29%). Complications such as perirenal haematoma, subcapsular haematoma or ureteral perforation were not observed. The vast majority of complications observed in the study were associated with urinary obstruction caused by partial blockage of the ureter with kidney stone fragments ("steinstrasse"). Despite the complications that were documented, ESWL should be considered a safe procedure.

What do we know about pulmonary blastoma?: review of literature and clinical case report.

Pulmonary blastoma (PB) is a rare form of lung tumour and is accountable for 0.25-0.5% of primary pulmonary malignancies. Initially pulmonary blastoma was divided into three subtypes: biphasic pulmonary blastoma (BPB) consisting of an epithelial and mesenchymal component, well differentiated fetal adenocarcinoma (WDFA) built of well differentiated epithelium and a mesenchymal component and malignant pleuropulmonary blastoma (PPB). Prognosis in this type of cancer is really poor. We present a current review of literature and a clinical case report. Treatment of PB is very difficult. Data and recommendations about the treatment of pulmonary blastoma are still available therefore we should use only observations and clinical case reports.

Voiding Disorders in Pediatrician's Practice.

Voiding disorders result usually from functional disturbance. However, relevant organic diseases must be excluded prior to diagnosis of functional disorders. Additional tests, such as urinalysis or abdominal ultrasound are required. Further diagnostics is necessary in the presence of alarm symptoms, such as secondary nocturnal enuresis, weak or intermittent urine flow, systemic symptoms, glucosuria, proteinuria, leukocyturia, erythrocyturia, skin lesions in the lumbar region, altered sensations in the perineum. Functional micturition disorders were thoroughly described in 2006, and revised in 2015 by ICCS (International Children's Continence Society) and are divided into storage symptoms (increased and decreased voiding frequency, incontinence, urgency, nocturia), voiding symptoms hesitancy, straining, weak stream, intermittency, dysuria), and symptoms that cannot be assigned to any of the above groups (voiding postponement, holding maneuvers, feeling of incomplete emptying, urinary retention, post micturition dribble, spraying of the urinary stream). Functional voiding disorders are frequently associated with constipation. Bladder and bowel dysfunction (BBD) is diagnosed when lower urinary tract symptoms are accompanied by problems with defecation. Monosymptomatic enuresis is the most common voiding disorder encountered by pediatricians. It is diagnosed in children older than 5 years without any other lower urinary tract symptoms. Other types of voiding disorders such as: non-monosymptomatic enuresis, overactive and underactive bladder, voiding postponement, bladder outlet obstruction, stress or giggle incontinence, urethrovaginal reflux usually require specialized diagnostics and therapy. Treatment of all types of functional voiding disorders is based on non-pharmacological recommendations (urotherapy), and such education should be implemented by primary care pediatricians.