What Factors Decide Urolithiasis Treatment?
Discussion
Although pediatric uroliathiasis is relatively rare, there has been an increasing number of children evaluated for renal stones over time. For an overview of uroliathiasis click here.
Renal colic classically has paroxysmal pain that is severe, radiates toward the groin and the patient is not able to find a comfortable position. They may also have irritability, nausea, emesis, increased urinary frequency, dysuria and hematuria. 85-90% of patients will have macro- or microscopic hematuria but up to 15% of patients with urolithiasis will not have hematuria.
Clinical differential diagnosis includes but is not limited to:
Appendicitis
Constipation
Gastroenteritis
Intussception
Ovarian torsion
Urinary tract infection
The most common locations for stones to lodge are the ureteropelvic junction, the ureterovesical junction and where the ureter crosses the common iliac vessels.
Learning Point
Size and location of the stone and if it is causing urinary obstruction guide treatment decisions. Stones that are smaller than 4 mm and that are non-obstructing are usually managed conservatively. Those that are larger than 4 mm or causing obstruction usually require interventional management. Stones that are higher up in the urinary tract are more likely to require intervention. If initially treated conservatively and after 3-6 weeks the patient’s stone has not resolved then interventional treatment is usually indicated.
Conservative management includes aggressive hydratio...
Source: PediatricEducation.org - Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news
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