Stone disease in kids rising, creating challenges


Although stone disease in pediatric patients is on the rise and minimally invasive techniques to deal with it are increasing, there is a lack of evidence-based standards to care for these patients.

Currently, several aspects of stone disease in pediatric patients warrant our attention, some of which are addressed in this issue of Urology Times.

Second, our ability to deal with all aspects of urolithiasis by minimally invasive techniques is increasing. What is correct for a given patient, however, remains to be established. I am sure that there will be further advances in this area.

Finally, pediatric urologists face a challenge in metabolically evaluating all of the children that we see today with urolithiasis. The younger a patient presents with urolithiasis, the greater the likelihood that an underlying metabolic cause will be found.

Unfortunately, the demand for metabolic evaluation is overwhelming our pediatric nephrology colleagues. This is the reason many centers, including The Children's Hospital of Philadelphia, have established within their urology departments a metabolic evaluation and management program for pediatric urolithiasis. We must continue to develop that resource in the future and standardize the evaluation, again to ensure that we efficiently and effectively care for children with stone disease and minimize their recurrence rate.

In conclusion, multiple challenges face the profession of urology in the management of pediatric urolithiasis, and it is my hope and my belief that our national meetings will reflect progress on all of these fronts.

Dr. Snyder, a member of the Urology Times Editorial Council, is professor of surgery in the department of urology at the University of Pennsylvania School of Medicine, Philadelphia.

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