Dr. Chan on how kidney stones are treated in pediatric patients

In this video, Katherine Chan, MD, MPH, discusses how kidney stones are treated in children. Chan is vice chair for research, director of the Pediatric Kidney Stone Clinic, director of Pediatric Urology Research, and an associate professor of urology at the University of North Carolina, Chapel Hill.

Transcription:

What treatment options are available for kidney stones in children, and how is the decision made between conservative management and surgical intervention?

The treatment options for children are variable. The first consideration is really whether or not the child is symptomatic and also how symptomatic are they. For people who have these asymptomatic small stones up in the kidney that really aren't causing any blockage, that's a different consideration than somebody who ends up in the emergency room in severe pain. The child who's asymptomatic, they may actually elect observation for their stones. That's certainly 1 possibility. The other possibility is electing a treatment for that stone. Essentially, there are 2 main treatments for these small kidney stones that aren't causing a problem. For example, there's something called extracorporeal shock wave lithotripsy, which is an external type of sound wave that's applied to the kidney to break up the kidney stones. The other one, of course, is ureteroscopy, where we pass a telescope up into the ureter and up into the kidney to treat the stone. So it's pretty much the shock wave lithotripsy or ureteroscopy, which are the treatment options if the family elects to treat it at all. The second category that I mentioned is, again, those patients who are acutely symptomatic [and who] may have severe pain from their stone. Assuming that they don't have any type of serious issue like an infection in the urine, they may be offered several options. One of those is basically a spontaneous passage. And that's maybe assisted with some medications to help them pass the stone more efficiently. And that would be something where we usually give them a trial of passage for about 2 to 3 weeks, potentially with some re-imaging to see whether or not that's been successful. The other option is, again, if somebody is in severe pain, is just to go ahead and place a stent, which is like a drainage tube for the ureter, and then move on to treating the stone ultimately, and again, we can look at possibly ureteroscopy, or even shock wave lithotripsy in that kind of scenario. The final treatment option, which is pretty uncommon in kids, and again, this is a difference between pediatric stone disease and adult stone disease, is percutaneous nephrolithotomy. Kids tend to form pretty small stones. As I like to say, "They are little people with small stones that cause big problems." And so, generally speaking, we don't see as many large kidney stones in children that really require a percutaneous approach. So generally speaking, that's pretty uncommon. In those types of scenarios we typically engage with our adult endourology colleagues and we'll send them to my adult colleagues for treatment.

This transcription was edited for clarity.