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The article discusses symptoms, risk factors, and treatment of urolithiasis in children. Topics explored include the increasing incidence of pediatric stone disease among the youth from 1999 to 2008, factors that contribute to urinary tract stone formation in children such as changes in diet, obesity, and hormones, and the administration of nonsteroidal anti-inflammatory drugs (NSAID) to manage pain associated with the condition.

Objectives: To report the largest series of pelvic fracture and lower genitourinary tract injury in the pediatric population to further define its incidence. The association between pelvic fractures and lower genitourinary tract injury has been well recognized in the adult population. The incidence of bladder or urethral injury is approximately 10% to 15%. Previous limited pediatric reviews placed its incidence at slightly lower levels.Methods: A retrospective review of 8021 trauma patients presenting between July 1992 and March 1999 to a pediatric trauma center included 212 consecutive patients with pelvic fractures. These records were reviewed to determine the incidence of genitourinary injury in children with pelvic fractures. Thirty-six patients were identified with a genitourinary injury, and their records were analyzed.Results. Thirty-six patients (17%) were identified to have sustained a genitourinary injury out of the study cohort of 212 patients with pelvic fractures when patients with isolated hematuria were included. Hematuria was noted in 30 patients (14.2%). Fourteen (6.6%) had gross hematuria. Only 2 (0.9%) of the 212 patients had a significant lower urinary tract injury (one extraperitoneal bladder rupture and one posterior urethral disruption); both had gross hematuria. Genital injuries were seen in 4 other patients (1.9%). Lower genitourinary injury occurred in a total of 6 (2.8%) of the 212 patients with pelvic fractures.Conclusions: The incidence of significant lower genitourinary injury in pediatric patients with pelvic fractures is lower than that reported in previous adult and pediatric reviews. Significant lower genitourinary injuries were not found in stable patients without gross hematuria or multiple associated injuries and with a normal genitourinary examination. [ABSTRACT FROM AUTHOR]

Purpose: The benefit of surgery on renal function in unilateral ureteropelvic junction stenosis (UPJS) is still debated. We evaluated renal function outcome after unilateral pyeloplasty in 53 children., Materials and Methods: We retrospectively reviewed 123I-hippuran renography performed at diagnosis and 5 to 15 years (mean +/- SD 7 +/- 3 years) after successful pyeloplasty. UPJS was prenatally detected in 26 children because of urinary tract infection in 17 and miscellaneous reasons in 10. Relative function (RF) and absolute function were measured on background corrected renograms. Absolute function of the affected and contralateral kidneys was determined by an accumulation index (AI), representing the percent injected dose extracted by each kidney 30 to 90 seconds after the heart peak., Results: Preoperatively 33 of the 53 UPJS kidneys had a decreased AI but only 8 had a RF of less than 40%, which was improved in 7 at followup. In addition, the AI improved in 29 kidneys, of which 19 (36%) normalized. Of the UPJS kidneys 14 had an initially decreased AI that remained abnormal at followup. In these kidneys preoperative RF was less than 40% in all. At followup RF was greater than 40% in 4 children, in whom the AI of the UPJS kidney did not improve but the AI of the contralateral one decreased from supranormal to normal. Seven contralateral kidneys had a supranormal AI, whereas the AI remained normal in 3, of which the RF in the UPJS kidney remained at less than 40%. The AI and RF were normal in 20 UPJS kidneys and remained normal., Conclusions: When normal, the AI and RF reflected renal function outcome similarly. The AI added relevant information in UPJS kidneys with impaired function, showing compensation of the contralateral kidney.

Purpose: Inpatient stays of 3 to 5 days are common in the surgical management of vesicoureteral reflux and often include the use of bladder catheters, ureteral stents and perivesical drains. We reviewed our recent experience, in which patients undergoing routine ureteroneocystostomy were often discharged home on postoperative day 1 to determine the safety and efficacy of our management., Materials and Methods: Between July 1998 and March 2001 patients who underwent intravesical ureteroneocystostomy at 2 major tertiary care institutions were identified. Patients who also underwent simultaneous additional operative procedures, bilateral ureteral duplication or ureteral tapering were excluded from study. Data recorded included patient demographics, the procedure, operative and postoperative pain, nausea and bladder spasm management, hospital stay, post-hospital discharge problems and operative success., Results: Of the 113 patients with complete data available for analysis 101 received ketorolac postoperatively, including 75 females and 26 males with a mean age of 5.01 years (range 6 weeks to 16 years). There were 67 bilateral and 34 unilateral reimplantations. No ureteral stents or perivesical drains were placed. A perioperative urethral Foley catheter was removed on postoperative day 1 in all except 3 cases. Caudal analgesia with 0.25% bupivacaine before or after the operation was given in 91% of cases as a single injection. Epidural catheters were not used. In the ketorolac group average hospitalization was 29.5 hours (range 14 to 72). Of the 101 patients 58% were discharged home within 24 hours (average 21.3) and a further 11% were discharged home within 36 hours (average 27.4). All except 4 patients (4%) were discharged home within 48 hours of surgery. In the 12 patients who did not receive ketorolac average hospital stay was 43.8 hours (p <0.001). Gender did not affect the duration of hospitalization. Patients younger than 1 or older than 5 years old had a longer hospital stay than children between 1 and 5 years old (average 32.8 versus 25.5 hours). All patients received anticholinergics. The 9 complications (8%) involved urinary tract infection in 3 cases, and persistent nausea and vomiting, medication reaction and reoperation for clot evacuation in 1 each. Postoperatively 3 patients had persistent refluxing ureters., Conclusions: Routine surgical repair of vesicoureteral reflux can be successful with early bladder catheter removal and without stents or drains, necessitating only overnight hospitalization in the majority of patients. Ketorolac can be given safely in children with minimal risk and when combined with caudal analgesia it facilitates early discharge home.