Urologists' reports of stones in pediatric patients varies by region.
I was a one-man band here for many years, but there are three on the faculty; I refer all stones to a colleague, but the incidence certainly seems much higher.
We have hot, humid summer weather, and heat and dehydration are factors-that's what constitutes a 'stone belt.' There may be genetic clusters, but that's really a very small proportion of the stones."
There are real questions about weight and diet changes that have pushed stones into the younger ages. Although I did a fellowship in stone disease, I haven't done any studies, but I strongly suspect it is related to weight and diet.
I am more likely to put a younger patient through a metaboloic evaluation-including urine studies and blood work-to look for medical causes, but also to see what their significant dietary components are. I may tell an older patient to drink more fluids, with general directions, but with younger patients, there is more to lose. You don't want them to get into a pattern of developing stones. You need to change dietary habits early on."
Paul Pietrow, MD
The county I work with has a contract with a pediatric urologist, so patients may find him directly, but I haven't seen any increase in pediatric patients. In fact, I rarely see any.
Among older patients, we do a lot-almost 50 lithotripsies in the past year. But again, we see a lot of people shunted to us without insurance or access to care.
They relate an increase in stones to obesity, and we certainly have a huge patient population problem with childhood obesity in the Hispanic group we see, but personally I haven't seen or heard of a problem with excess stones, maybe one or two a year."
Paul Silverman, MD