The evolution, over 24 years, of the management of pediatric stones after the introduction of minimally invasive procedures: A single-center experience, "Beyond the Abstract," by Bulent Onal, MD, FEBU and Sinharib Citgez

BERKELEY, CA ( - Urolithiasis is an endemic disease in our country (Turkey), and, as stated by Tellaloglu, et al. in 1984[1] has an incidence rate of 17% in children. The significance of pediatric stone disease is underscored by the fact that children have a higher lifetime risk of recurrence and, for this reason, endourological procedures are preferable to repeated open surgeries. With improvements in instrumentation and technology, endoscopic management has become safer and effective.

The aim of this study is to compare the current management of pediatric stone surgery at our institution to management prior to the introduction of endourological procedures, and to assess the impact of new technology on the management of pediatric urolithiasis by analyzing our local practice as it has evolved over the past 24 years. In the past 30 years, since the introduction of endoscopic managements, including extracorporeal shock wave lithotripsy (ESWL), percutaneous nephrolithotomy (PCNL), and ureteroscopy (URS), surgical practice of urolithiasis has dramatically changed towards these much less-invasive procedures and away from open surgery. Following the successful results in adults, minimal invasive modalities rapidly became a standard treatment for children with urolithiasis as well, while previously, most children with urinary stones underwent open surgery.[2]

A total of 867 procedures were performed at our institute, for the purpose of stone removal or fragmentation, between 1987 and 2010, in children who were 17-years-old or younger. Retrospective chart review of these children was performed, focusing on age at presentation, treatment alternatives performed, and outcome. Data were analyzed with respect to the patient characteristics and changing patterns of treatment, with time, in our clinic. We compared the types of procedures performed during first (1987-1992), second (1993-1998), third (1999-2004) and fourth periods (2005-2010). First period included the time before ESWL, second period was the introduction of ESWL, third period was the introduction of PCNL and fourth period was our experienced period, with the addition of a pediatric urologist to our clinic. Procedures were categorized as follows: ESWL, URS, PCNL, endoscopic urethral and bladder stone extraction and open surgery. Children were evaluated by IVU and/or ultrasonography, 12 weeks after the treatment. The stone-free rates were determined according to the periods.

Complete data were available on 783 procedures in 768 children. Stone location was renal in 495, ureteral in 228, bladder in 21, urethral in 11, and the remaining 13 had stones with multiple locations. The mean age of the children was 7.50 years (range from 9 months to 17 years). Of 783 procedures performed for the treatment of urolithiasis in children, 75.9% were open surgery during first period (1987-1992). This rate was 29.7% during second period (1993-1998), 6.1% during third period (1999-2004) and 0.2% during fourth period (2005-2010). The number of children who underwent urinary stone treatment increased significantly (p=0.001) and the age of the children at the time of surgery decreased (9.09 to 6.08) (p=0.001) with time.

As a result, the advances in instruments technology provide a variety of safe and effective endourological procedures, such as ESWL, PNL and ureteroscopy for the treatment of pediatric urolithiasis in children. During a 24-year period, our management had shifted from open surgery to endourological procedures with the advances in technology and developments in endourology. Technologic advances and improved surgical skills have greatly reduced the number of children requiring open surgery. This approach is mainly used for children with complex urinary calculi disease presented with anatomic abnormalities.


  1. Tellaloglu S and Ander H. Stones in children. Turk J Pediatr, 1984;26(1-4):51-60.
  2. Zargooshi J. Open Stone surgery in children: is it justified in the era of minimally invasive therapies? BJU Int, 2001;88(9):928-31.


Written by:

Bulent Onal* and Sinharib Citgez as part of Beyond the Abstract on This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.

*Bulent Onal, MD, FEBU
Associate Professor in Urology
Cerrahpasa School of Medicine
Istanbul University
Istanbul, Turkey

What changed in the management of pediatric stones after the introduction of minimally invasive procedures? A single-center experience over 24 years - Abstract

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