We have read the paper entitled “Management of pediatric ureterolithiasis in the emergency
room: A single institution review and new management pathway”. We congratulate the
authors for discussing one of the very important topics in pediatric patients. In
the present study, authors found that medical expulsive treatment (MET) is underutilized in pediatric patients with ureteral stones even if MET is very
effective with significantly high rate of stone passage. They also mentioned that
the reason for this underutilization is related to noninvolvement of pediatric urologists
for the management of these patients [
[1]
]. It is well-known that stone disease in children is related to metabolic, anatomical,
infectious, and nutritional factors. All ages of the childhood, and both genders can
be affected equally. The incidence of stone disease in children was reported to be
between 0.1 and 5% [
[2]
]. Ureteral stones constitute 20% of all cases with urinary system stone disease.
Seventy percent of ureteral stones are localised in the distal ureter [
]. Choice of treatment for the pediatric patients with ureteral stones is determined
based on the location, size, urinary system anatomy, available technology, cost of
the treatment, experience of the physician, and preference of both the physician and
the patient's parents [
[4]
].To read this article in full you will need to make a payment
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References
- Management of pediatric ureterolithiasis in the emergency room: a single institution review and new management pathway.J Pediatr Urol. 2022 Nov; (17:S1477-5131(22)00526-5. https://doi.org/10.1016/j.jpurol.2022.11.015)
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- Stones in the ureter.Acta Chir Scand. 1973; 433: 66-71
- Medical expulsive treatment in pediatric urolithiasis.Turk J Urol. 2015; 41: 39-42
- EAU/AUA Nephrolithiasis Guideline Panel. 2007 guideline for the management of ureteral calculi.J Urol. 2007; 178: 2418-2434
- Natural history of conservatively managed ureteral stones: analysis of 6600 patients.J Endourol. 2018; 32: 371-379
EAU guideline on urolithiasis. Skolarikos A, Neisius A, Petřík A, Somani B, Thomas K, Gambaro G. https://uroweb.org/guidelines/urolithiasis, 2022.
- Silodosin versus tamsulosin for medical expulsive therapy of ureteral stones: an updated systematic review and meta-analysis of randomized controlled trials.Medicina (Kaunas). 2022; 58: 1794
- The efficacy and safety of adrenergic alpha-antagonists in treatment of distal ureteral stones in pediatric patients: a systematic review and meta-analysis.J Pediatr Surg. 2017; 52: 360-365
- Medical and surgical interventions for the treatment of urinary stones in children.Cochrane Database Syst Rev. 2019; 10CD010784
- Treatment of distal ureteral stones in children: similarities to the american urological association guidelines in adults.J Urol. 2000; 164: 1089-1093
- Pediatric urolithiasis: experience from a tertiary referral center.J Pediatr Urol. 2013; 9: 825-830
- Tamsulosin versus nifedipin in medical expulsive therapy for distal ureteral stones and the predictive value of Hounsfield unit in stone expulsion.Ren Fail. 2014; 36: 1541-1544
- Comparative study between silodosin and tamsulosin in expectant therapy of distal ureteral stones.Urol Int. 2018; 101: 161-166
Article info
Publication history
Published online: February 22, 2023
Accepted:
February 3,
2023
Received:
February 1,
2023
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Management of pediatric ureterolithiasis in the emergency room: A single institution review and new management pathwayJournal of Pediatric UrologyVol. 19Issue 2
- PreviewUrolithiasis is an increasingly common condition seen in children with an annual incidence of 2–3% in children under 18, and up to 10% in adolescents. Treatment of stones varies including observation, IV hydration, pain management, medical expulsive therapy (MET), or surgery. Though well-studied and often used in adults, MET (alpha-adrenergic antagonists to facilitate passage of ureteral stones), is not routinely prescribed in pediatric patients.
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- Response to letter to the editor re management of pediatric ureterolithiasis in the emergency room: A single institution review and new management pathwayJournal of Pediatric Urology
- PreviewThank you for your comments and input. We agree that pediatric urolithiasis is an important topic, and that MET is often underutilized in this population. Based on the known benefits and potential to avoid surgery, the authors feel it is reasonable to prescribe MET with a 2-to-4-week trial of stone passage for any unilateral ureteral stone <10 mm in an appropriately selected patient. Although we did find that use of MET increased with urology involvement, we respectfully disagree that urology should be involved for every stone patient seen in the emergency room.
- Full-Text
- Preview
