Minimally invasive therapeutic modalities for pediatric urolithiasis: A single center experience from the Philippines

ABSTRACT

Introduction@#There is a limited data on the incidence of pediatric urolithiasis in the Philippines as well as studies on how it is managed. With the advent of endourology, there is already an evident shift from open stone surgery to minimally invasive surgery as first line in the treatment of pediatric urolithiasis. A tertiary referral center in the country caters to most pediatric urolithiasis cases in the country and offers the different minimally invasive modalities outlined in the latest guidelines. This study aimed to review the different minimally invasive therapeutic modalities for pediatric urolithiasis and its outcomes in the past ten years in a tertiary referral center in the Philippines.@*Methods@#This retrospective study was conducted through charts review of all pediatric patients (0-18 years) who underwent stone surgery from January 2012 to December 2022. Demographic and clinical data, stone characteristics, types of stone surgery, and outcomes were obtained.@*Results@#A total of 87 pediatric patients (54 boys, 33 girls) with 105 urolithiases were analyzed. The patients had a mean age of 13 years, with an interquartile range (IQR) spanning from 6 to 18 years. Among them, 62.07% were male, while 37.93% were female. The most prevalent symptom reported was flank pain, affecting 41.38% of the patients, followed by urinary tract infections (UTI) (11.49%) and gross hematuria (8.05%). For the management, 82.86% of the patients underwent minimally invasive stone procedures with extracorporeal shockwave lithotripsy (ESWL) as the most common procedure (44.76%) and ureterolithiases as the most common stone (43.81%). On the other hand, 17.14% of the subjects underwent open stone surgery done mostly on cystolithiases and large ureterolithiases (38.89% each). All patients recovered and were discharged post operatively.@*Conclusion@#The institution practices minimally invasive approaches in the majority of pediatric patients with urolithiasis. Open stone surgery is reserved for patient with large complex stones and those with anatomic abnormalities.