Clinical effectiveness in the diagnosis and acute management of pediatric nephrolithiasis

INTERNATIONAL JOURNAL OF SURGERY

卷:36

Review

Van Batavia, Jason P.¹  Tasian, Gregory E.^2,3,4 

[1] Childrens Hosp Philadelphia, Div Urol, 3rd Floor, Wood Bldg 34th & Civic Ctr Blvd, Philadelphia, PA 19104 USA

[2] Univ Penn, Perelman Sch Med, Ctr Clin Epidemiol & Biostatist, Div Urol & Epidemiol, Philadelphia, PA 19104 USA

[3] Childrens Hosp Philadelphia, Div Urol, Philadelphia, PA USA

[4] Childrens Hosp Philadelphia, Ctr Pediat Clin Effectiveness, Philadelphia, PA USA

关键词: Pediatrics;    Nephrolithiasis;    Urinary stone disease;    Urology;    Diagnostic imaging;   

DOI  :  10.1016/j.ijsu.2016.11.030

来源: Elsevier

【 摘 要 】

The incidence of pediatric nephrolithiasis has risen over the past few decades leading to a growing public health burden. Children and adolescents represent a unique patient population secondary to their higher risks from radiation exposure as compared to adults, high risk of recurrence, and longer follow up time given their longer life expectancies. Ultrasound imaging is the first-line modality for diagnosing suspected nephrolithiasis in children. Although data is limited, the best evidence based medicine supports the use of alpha-blockers as first-line MET in children, especially when stones are small and in a more distal ureteral location. Surgical management of pediatric nephrolithiasis is similar to that in adults with ESWL and URS first-line for smaller stones and PCNL reserved for larger renal stone burden. Clinical effectiveness in minimizing risks in children and adolescents with nephrolithiasis centers around ED pathways that limit CT imaging, strict guidance to ALARA principles or use of US during surgical procedures, and education of both patients and families on the risks of repeat ionizing radiation exposures during follow up and acute colic events. (C) 2016 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

【 授权许可】

Free