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Kid-size Kidney Stones
A New Concern for Parents
By Suzy Feine
A variety of procedures are available to a child diagnosed with kidney stones, depending on the size and location of the stone. The first method is observation – waiting for the stone to pass out of the body in the urine on its own. This method, also called spontaneous passage, is recommended for smaller stones. Medications are often used to ease the pain, and the patient is asked to drink lots of water to help move the stone through the ureter.
Extracorporeal shock wave lithotripsy (SWL) is a procedure used to break apart larger stones, enabling the smaller fragments to pass easily through the ureter. A lithotripter makes shock waves that travel through the body, creating stress on the stone. The doctor uses ultrasound to focus the waves on the stone inside the patient's body until the stone eventually crumbles. Following this procedure, a stent is often inserted through the urethra and bladder and into the ureter, assisting the fragments to pass through the ureter.
Ureteroscopy (URS) involves inserting a ureteroscope up the urethra, through the bladder and into the ureter, allowing the doctor to view the stone. Ureteroscopes contain channels that allow the doctor to insert various devices through the channels to remove or fragment the stone. A stent is left in the ureter for a few days following the procedure to aid in healing.
When stones become lodged in the upper ureter, percutaneous nephrolithotomy (PNL) is often performed. PNL involves making a small incision in the flank area of the skin. A thin guide wire is inserted through the incision, into the kidney and down the ureter with the aid of X-rays to allow the doctor to guide the wire. Dilators are inserted to stretch the tissue, creating a passageway that allows the doctor to vie the stone, break the stone using sound waves and then remove the stone fragments. A small tube into the kidney is left in place for a few days to aid in a second PNL, if necessary.
Maintaining Kidney Health