Journal of Pediatric Urology最新文献

{"title":"Letter to the Editor on “Hui-Jing technique for one-stage severe primary hypospadias repair: Long-term analysis compared to the Cloutier/ Bracka technique”","authors":"Antonio Macedo Jr, Débora Laena Barroso Sacoman","doi":"10.1016/j.jpurol.2025.04.044","DOIUrl":"10.1016/j.jpurol.2025.04.044","url":null,"abstract":"","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":"21 5","pages":"Page 1143"},"PeriodicalIF":1.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144317179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An objective analysis of > 600 paired hypospadias graft measurements: Prepuce vs oral graft take and HBOT effect","authors":"Nicol Bush,&nbsp;Hazem Mosa,&nbsp;Warren Snodgrass","doi":"10.1016/j.jpurol.2025.06.018","DOIUrl":"10.1016/j.jpurol.2025.06.018","url":null,"abstract":"<div><h3>Introduction</h3><div><span><span>Urethroplasty graft outcomes have traditionally been assessed subjectively, limiting comparison and understanding of graft success. We used standardized graft measurements to objectively evaluate graft take in primary prepucial and reoperative oral grafts, and assessed the effect of </span>hyperbaric oxygen therapy (HBOT) in </span>reoperations.</div></div><div><h3>Aims</h3><div>Primary: Validate graft area measurement as an bojective tool to compare graft take between primary and reoperative grafts.</div><div>Secondary: Correlate graft contracture with complications. Tertiary: Evaluate HBOT's impact in reoperations.</div></div><div><h3>Methods</h3><div><span>A Prospective cohort of staged hypospadias<span> repairs (2014–2023) was studied, excluding single-stage repairs. A two-stage STAG or three-stage STAC technique was used. </span></span>Prepuce<span> was used in primary grafts, oral mucosa in reoperations. Graft length and width were measured at placement and tubularization to calculate graft area take. Complications and HBOT use were documented. HBOT was administered post-placement in reoperations as per protocol.</span></div></div><div><h3>Results</h3><div>627 grafts were analyzed. Graft take was 93 % in prepucial grafts, 92 % in +HBOT oral grafts, and 83 % in -HBOT (p = 0.011). Graft contracture and failure significantly predicted complications. HBOT significantly reduced these risks.</div></div><div><h3>Conclusions</h3><div>Standardized graft measurement reliably assesses graft take. Contracture ≥20 % predicts higher complications. HBOT improves outcomes in reoperations to levels seen in primary repairs.</div></div>","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":"21 5","pages":"Pages 1342-1345"},"PeriodicalIF":1.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144540638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Electrotherapy in pediatric patients with non-neurological pelvic floor dysfunctions: A systematic review","authors":"Jordi Calvo-Sanz ,&nbsp;Karima Bouallalene-Jaramillo","doi":"10.1016/j.jpurol.2025.06.010","DOIUrl":"10.1016/j.jpurol.2025.06.010","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;&lt;span&gt;“Pelvic floor dysfunctions in children, such as enuresis&lt;span&gt;&lt;span&gt;, encopresis&lt;span&gt;, and bladder dysfunction, significantly affect both children and their families. Traditional treatments include behavioral therapies, pharmacological approaches, and physiotherapy. In recent years, the use of &lt;/span&gt;&lt;/span&gt;electrotherapy&lt;span&gt;, specifically transcutaneous electrical nerve stimulation (TENS)&lt;/span&gt;&lt;/span&gt;&lt;/span&gt;&lt;em&gt;,&lt;/em&gt;&lt;span&gt; has emerged as a promising non-invasive option for treating urinary&lt;span&gt;&lt;span&gt;&lt;span&gt; and fecal dysfunctions, demonstrating effectiveness in reducing symptoms of overactive bladder, enuresis, and constipation. The aim of this &lt;/span&gt;systematic review&lt;span&gt; is to determine the efficacy of electrotherapy in any of its applications and classifications by low, medium or high frequency emission frequency for the treatment of pelvic floor dysfunctions in pediatric patients without &lt;/span&gt;&lt;/span&gt;neurological pathologies&lt;span&gt;. The most commonly used parameterisation is analysed, as well as its effect on the reduction of faecal and urinary incontinence and its use as an alternative or complement to conventional treatments such as behavioural therapy and pharmacology.&lt;/span&gt;&lt;/span&gt;&lt;/span&gt;&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Materials and methods&lt;/h3&gt;&lt;div&gt;&lt;span&gt;This systematic review adhered to PRISMA guidelines. A literature search was conducted using PubMed, PEDro, and Cochrane databases, focusing on clinical trials published in the last 10 years. Inclusion criteria targeted pediatric patients with non-neurological pelvic floor dysfunctions. Studies involving &lt;/span&gt;acupuncture or incomplete data were excluded and also articles below a score of 5 on the PEDro scale.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Eleven studies met the inclusion criteria, involving 495 pediatric participants aged 3–18 years. The studies primarily explored TENS, percutaneous TENS (PTENS), and interferential current stimulation (IFS). Sessions were conducted 2–3 times per week over 3 months, with frequencies ranging from 10 to 55 Hz. Electrodes were predominantly placed externally over the sacral area (S2–S3). Significant improvements were observed in experimental groups, including reduced incontinence, increased bladder capacity&lt;span&gt;, and enhanced quality of life, though one study reported no significant changes.&lt;/span&gt;&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Discussion&lt;/h3&gt;&lt;div&gt;The reviewed studies highlight the effectiveness of TENS and related techniques for pelvic floor dysfunctions in children. TENS parameters, such as 10 Hz frequency and sacral electrode placement, showed consistent results for urinary and fecal incontinence. Combining TENS with biofeedback or urotherapy further improved outcomes. Despite positive results, disparities remain in session duration and frequency. Further research is needed to refine protocols and confirm long-term effects.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;TENS, biofeedback, and behavioral therapies, either indepen","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":"21 5","pages":"Pages 1076-1086"},"PeriodicalIF":1.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144560378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mirabegron as part of combination therapy for treatment refractory neurogenic bladder in pediatric patients with spina bifida","authors":"Tyler Gaines ,&nbsp;Paul Campbell ,&nbsp;Katherine Fischer ,&nbsp;Jason Van Batavia ,&nbsp;Dana Weiss ,&nbsp;Stephen Zderic ,&nbsp;Michael Daugherty ,&nbsp;Brian VanderBrink ,&nbsp;Christopher Long","doi":"10.1016/j.jpurol.2025.01.016","DOIUrl":"10.1016/j.jpurol.2025.01.016","url":null,"abstract":"<div><h3>Introduction</h3><div>Medical therapy for patients with neurogenic bladder<span><span><span> secondary to spina bifida is a key element in their management. </span>Mirabegron<span> has been shown to improve abnormal bladder wall dynamics in the </span></span>neurogenic bladder<span> (NGB) population, but there is limited information on its efficacy as additive therapy in the treatment of refractory NGB in pediatric literature.</span></span></div></div><div><h3>Objective</h3><div><span><span><span>This study assessed the utility of mirabegron as combination therapy in pediatric patients with spina bifida who have insufficient improvement of </span>bladder dynamics on antimuscarinic </span>monotherapy. We hypothesized that using mirabegron in combination with antimuscarinic therapy would lead to improved bladder dynamics on repeat </span>urodynamic studies.</div></div><div><h3>Study design</h3><div>This was a retrospective review of pediatric patients treated at 2 centers were included if there were high-risk urodynamic findings and/or persistent incontinence on a single antimuscarinic agent. Pre and post dual therapy initiation urodynamic assessment was performed.</div></div><div><h3>Results</h3><div>We included 103 patients at a median age of 10.7 years on a median of 166 days of treatment. Dual therapy lowered detrusor<span> opening pressures and end filling pressures, in addition to improving detrusor overactivity in 32 % of patients, even in the patients with the highest risk bladders (Figure).</span></div></div><div><h3>Discussion</h3><div>Limitations of the study include the retrospective design, the subjectivity of the treating physician in initiating Mirabegron, and the variability in urodynamic assessment. Our findings are consistent with the benefits of dual therapy in adult patients, extending this treatment option to the pediatric population.</div></div><div><h3>Conclusion</h3><div>The addition of mirabegron resulted in improvement in storage pressures and subjective incontinence in pediatric spina bifida patients not adequately managed with a single antimuscarinic agent.</div></div>","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":"21 5","pages":"Pages 1233-1238"},"PeriodicalIF":1.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143370772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Strain elastography for fertility assessment after pediatric testicular torsion: A long-term follow-up study","authors":"Süleyman Arif Bostancı ,&nbsp;Ayşe Özdemir Gökçe ,&nbsp;Gülşah Kiriş Uzun ,&nbsp;Sarper Müftüoğulları ,&nbsp;Vildan Selin Çayhan ,&nbsp;Elif Emel Erten ,&nbsp;Sabri Demir ,&nbsp;Müjdem Nur Azılı ,&nbsp;Ayşe Seçil Ekşioğlu ,&nbsp;Emrah Şenel","doi":"10.1016/j.jpurol.2025.05.021","DOIUrl":"10.1016/j.jpurol.2025.05.021","url":null,"abstract":"<div><h3>Introduction</h3><div><span><span>Testicular torsion (TT) is a urological emergency characterized by the twisting of the </span>spermatic cord, leading to </span>ischemia<span><span><span> and potential testicular damage. If not treated promptly, TT can result in testicular atrophy and infertility. While early surgical intervention restores blood flow, the long-term impact on fertility remains a concern. This study investigates the role of strain </span>elastography (SE) and testicular volume measurements in assessing </span>testicular function after TT.</span></div></div><div><h3>Objective</h3><div>To evaluate the importance of strain elastography and testicular volume measurements in the long-term fertility assessment of adolescent patients who underwent surgery for TT.</div></div><div><h3>Study design</h3><div>This retrospective observational study included 15 patients operated on for TT between 2014 and 2020. Data on patient demographics, age at surgery, torsion laterality, symptom duration, degree of torsion, follow-up period, and semen analysis results were collected. SE and testicular volume measurements were performed during follow-up. Patients were classified as fertile or subfertile based on semen analysis. Statistical analyses were conducted using SPSS, including independent sample t-tests and Pearson correlation analysis.</div></div><div><h3>Results</h3><div><span>The volume of the torsed testis was significantly reduced compared to the </span>contralateral testis (p = 0.0001). In the fertile group, there was a strong correlation between the affected and contralateral testis elastography values (r = 0.948), whereas this correlation was weak in the subfertile group (r = 0.158). The results suggest that in the fertile group, both testicles exhibited similar elastographic changes, while in the subfertile group, the affected testis showed independent variations.</div></div><div><h3>Conclusion</h3><div>This study highlights the importance of strain elastography and testicular volume measurements in the long-term assessment of fertility following TT. These techniques provide valuable insights into testicular function and potential fertility. Further research with larger cohorts and extended follow-up is needed to validate these findings.</div></div>","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":"21 5","pages":"Pages 1329-1334"},"PeriodicalIF":1.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144225786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to commentary on “Augmentation cystoplasty and continent catheterizable channels in the bladder exstrophy – epispadias complex: A 20-year experience”","authors":"Victoria Maxon,&nbsp;John P. Gearhart","doi":"10.1016/j.jpurol.2025.05.025","DOIUrl":"10.1016/j.jpurol.2025.05.025","url":null,"abstract":"","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":"21 5","pages":"Page 1075"},"PeriodicalIF":1.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144340229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Koyanagi-Hayashi technique: An attractive technique for the severe hypospadias repair","authors":"H. Benhaddou ,&nbsp;H. Azzam","doi":"10.1016/j.jpurol.2024.11.010","DOIUrl":"10.1016/j.jpurol.2024.11.010","url":null,"abstract":"<div><h3>Introduction</h3><div><span>In the armamentarium of techniques used to reconstruct proximal hypospadias, deciding which to use is difficult, and the </span>reoperation rate is high whichever procedure is chosen. The Koyanagi-Hayashi techniqueis an alternative for urethral reconstruction.</div></div><div><h3>Objective</h3><div>The main objective of our study is to focus on this technique and to evaluate its results in the pediatric<span> visceral and urogenital surgery department of Mohammed VI Oujda University.</span></div></div><div><h3>Materials and methods</h3><div><span><span>22 patients (median age 7,5 years, range 12 months–14 years) presented with proximal hypospadias and were operated by the same surrgeon according to the modified Koyanagi - Hayashi technique. The average of following's patients was 04 years. Ventral </span>chordée is found in 17 children (77 %), the average measured degree during surgery (artificiat erection test) was 15° (12–20°). A </span>micropenis<span><span><span><span> (penis lenth less than 25 mm) was assessed in 12 (54.5 %) of cases, and scrotal abnormality was found in 10 (45.5 %) cases. Hormone therapy before surgery using </span>dihydrotestosterone gel 2.5 % for one month has been indicated by the </span>pediatric endocrinologist in patients with a </span>micropenis (in patients aged less than 2 years) (12 cases, 54.5 % of cases). Stents or catheters were used in all patients.</span></div><div>The mediane age for surgery was 7.5 years (12 months- 14 years).²</div></div><div><h3>Results</h3><div><span>The success rate from the first intervention is 59 % with penile straightening obtained in all patients. The complications observed were: fistula (36 %), meatal </span>stenosis<span> (13 %) and partial failure of uretroplasty (9 %). These complications led to 10 surgical revisions: urethrocutaneous fistula 8 of cases or 36 %), dehiscence of the glans (2 cases or 9 %).</span></div><div>A third intervention was necessary in a single patient whose indication was glans dehiscence (4.5 %). The final result in our series is considered satisfactory.</div></div><div><h3>Conclusion</h3><div>The modified Koyanagi-Hayashi technique is an attractive alternative for proximal hypospadias repair with satisfactory results and considerable but manageable complications. In our series the success rate was 58.6 %. The main limit of this study is shortness of study (only 22 cases).</div></div>","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":"21 5","pages":"Pages 1164-1169"},"PeriodicalIF":1.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144326090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Commentary to “Strain elastography for fertility assessment after pediatric testicular torsion: A long-term follow-up study”","authors":"Sujit K. Chowdhary","doi":"10.1016/j.jpurol.2025.06.026","DOIUrl":"10.1016/j.jpurol.2025.06.026","url":null,"abstract":"","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":"21 5","pages":"Page 1335"},"PeriodicalIF":1.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144659500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How to use quality improvement methodology to track missed care opportunities for urodynamics appointments and identify key drivers for future interventions","authors":"Kaitlin Scarpaci,&nbsp;Christina Chen,&nbsp;Mary Micker,&nbsp;Hunter Gibbs,&nbsp;Perry Harlan,&nbsp;Celicia Little,&nbsp;Nicole Allentuck,&nbsp;Bruce M. Sprague,&nbsp;Hans G. Pohl,&nbsp;Christina P. Ho,&nbsp;Briony K. Varda","doi":"10.1016/j.jpurol.2025.06.022","DOIUrl":"10.1016/j.jpurol.2025.06.022","url":null,"abstract":"<div><div>Missed care opportunities (MCOs) can negatively affect patients, providers and institutions. In 2022, we established a prospective quality improvement (QI) database to track MCOs for urodynamics (UDS). Between 2022 and 2024, 877 appointments were scheduled. The MCO rate was 29 %. Patients with spina bifida (SB) undergoing non-video UDS accounted for 79 % of MCOs. This sub-group was sensitive to reminder type, with MCOs driven down by human phone reminders then rising above the median MCO rate with text reminders (aOR 1.5 [95 % CI 1.09–2.14], p = 0.02). This knowledge, alongside practitioner-assigned reasons for MCOs, has informed targeted QI interventions.</div></div>","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":"21 5","pages":"Pages 1357-1359"},"PeriodicalIF":1.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144649799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comprehensive analysis of pediatric urolithiasis in a tertiary care center and insights into demographics, risk factors, and management outcomes","authors":"Umay Kavgacı ,&nbsp;Bora Gulhan ,&nbsp;Eda Didem Kurt-Sukur ,&nbsp;Ali Düzova ,&nbsp;Hasan Serkan Dogan ,&nbsp;Serdar Tekgul ,&nbsp;Rezan Topaloglu ,&nbsp;Fatih Ozaltin","doi":"10.1016/j.jpurol.2025.03.006","DOIUrl":"10.1016/j.jpurol.2025.03.006","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Pediatric&lt;span&gt; urolithiasis is a growing global health concern, with increasing incidence and potential risks for chronic kidney disease&lt;span&gt; if untreated. Contributing factors include metabolic disorders&lt;span&gt;, genetic predisposition, dietary influences, and regional variations. Despite advancements in diagnosis and treatment, management remains challenging, particularly in high-risk infants.&lt;/span&gt;&lt;/span&gt;&lt;/span&gt;&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Objective&lt;/h3&gt;&lt;div&gt;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.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;We retrospectively analyzed 308 children (0–18 years) diagnosed with urinary&lt;span&gt; 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.&lt;/span&gt;&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;&lt;span&gt;&lt;span&gt;&lt;span&gt;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, &lt;/span&gt;hypocitraturia (46.5 %), &lt;/span&gt;hyperoxaluria&lt;span&gt; (36 %), and hypercalciuria&lt;span&gt; (11.3 %) were common. Infants had higher rates of bilateral and multiple stones, while older children had larger stones (&gt;5 mm, p &lt; 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 %), &lt;/span&gt;&lt;/span&gt;&lt;/span&gt;percutaneous nephrolithotomy (8.8 %), ureterorenoscopy (12.3 %), and open surgery (2.3 %).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Discussion&lt;/h3&gt;&lt;div&gt;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 ","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":"21 5","pages":"Pages 1051-1058"},"PeriodicalIF":1.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143710374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}