Comprehensive analysis of pediatric urolithiasis in a tertiary care center and insights into demographics, risk factors, and management outcomes.

Abstract

Background: Pediatric urolithiasis is a growing global health concern, with increasing incidence and potential risks for chronic kidney disease if untreated. Contributing factors include metabolic disorders, genetic predisposition, dietary influences, and regional variations. Despite advancements in diagnosis and treatment, management remains challenging, particularly in high-risk infants.

Objective: This study investigates the clinical characteristics, metabolic risk factors, and treatment outcomes of pediatric urolithiasis in a tertiary care center in Türkiye. Special attention is given to infants, assessing their distinct metabolic and clinical features, treatment responses, and the effectiveness of conservative management. Additionally, factors influencing stone burden and recurrence are evaluated to support individualized, risk-based management.

Methods: We retrospectively analyzed 308 children (0-18 years) diagnosed with urinary stones. Demographic data, clinical presentation, laboratory and imaging findings, treatment strategies, and outcomes were reviewed. Metabolic evaluations included urinary levels of citrate, oxalate, and calcium. Treatment approaches varied based on stone size, location, and symptoms, ranging from conservative management to medical therapy and surgical interventions.

Results: The median age at diagnosis was 12.5 months (range: 0-214), with a high prevalence of infant-onset cases. A family history of urolithiasis was present in 59.9 %, and parental consanguinity in 31.2 %. At the first visit, hypocitraturia (46.5 %), hyperoxaluria (36 %), and hypercalciuria (11.3 %) were common. Infants had higher rates of bilateral and multiple stones, while older children had larger stones (>5 mm, p < 0.001). Among infants with bilateral, multiple stones, hypocitraturia and hyperoxaluria were detected in 68.7 % and 66.1 %, respectively at follow-up, emphasizing the need for serial metabolic assessments. Nearly 70 % of patients received medical therapy, primarily Shohl's solution, while 28.2 % were managed conservatively. Among those with stones ≤5 mm, one-third were observed without intervention, with no significant difference in stone-free rates. Surgical interventions included extracorporeal shock wave lithotripsy (21.8 %), percutaneous nephrolithotomy (8.8 %), ureterorenoscopy (12.3 %), and open surgery (2.3 %).

Discussion: Comparable stone-free rates between treated and untreated small stones (≤5 mm) support the role of conservative management in selected cases without metabolic risk factors. However, the high rate of surgical interventions highlights the need for individualized treatment. Early-onset urolithiasis is frequently bilateral and multiple, reinforcing the importance of serial urine testing for accurate diagnosis.

Conclusion: Pediatric urolithiasis generally has a favorable prognosis with early diagnosis and tailored management. High-risk infants require proactive metabolic evaluation and long-term follow-up, as metabolic abnormalities may not be present at initial diagnosis. These findings support a risk-based, individualized approach to pediatric urolithiasis management.