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
Kingston, NY
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
Ventura, CA
ER utilization and overtreatment for UTI in pediatric patients with spina bifida
July 16th 2024"We've been working with families and other providers to learn the diagnostic criteria for what makes a urinary tract infection and to avoid treating when it's unnecessary," says Briony K. Varda, MD, MPH.