Steintherapie im Kindesalter

Zusammenfassung

Die Behandlungsmodalitäten in der Therapie der kindlichen Urolithiasis sind einem stetigen Wandel unterworfen. Aufgrund von Effizienz und niedriger Morbidität gilt die ESWL bis heute als Therapie der ersten Wahl bei kindlichen Ureter- und Nierensteinen. Entwicklungen im Bereich minimal invasiver Verfahren eröffnen jedoch zunehmend mehr Behandlungsoptionen. Insbesondere bei der Behandlung distaler Uretersteine muss die extrakorporale Stoßwellenbehandlung als primärer Therapieansatz kritisch überdacht werden. Im Vergleich zur ESWL zeigt die URS in diesem Bereich eine deutlich höhere Effizienz. Auch in der Therapie komplexer und großer Nierensteine sollte vermehrt die Anwendung der mini PCNL erwogen werden. Das Größenverhältnis von Nierenhohlsystem und Instrumentarium limitiert den Einsatz bei Kleinkindern und Säuglingen. Bei geringen Patientenzahlen bleibt die Bereitstellung des Instrumentariums und Anwendung der entsprechenden Techniken größeren Zentren vorbehalten.

Abstract

The extracorporeal shock-wave lithotripsy (ESWL) is still the treatment of choice for almost all stones in children. But with advances in instrumentation, endourological procedures are being performed more frequently in younger patients. Especially in the treatment of distal ureteral stones retrograde ureteroscopy now competes with ESWL. Finally, the recent literature supports percutaneous nephrolithotomy as a safe and effective treatment option for large renal calculi and staghorn calculi. This gives the clinician the opportunity to choose from a wide range of treatment alternatives. Proper treatment planning, technique and availability of appropriate instrumentation are important to achieve an optimal outcome.

Schlüsselwörter

kindliche Urolithiasis - extrakorporale Stoßwellenlithotripsie - Ureterorenoskopie - perkutane Nephrolitholapaxie

Key words

pediatric urolithiasis - extracorporeal shock-wave lithotripsy - retrograde ureteroscopy - percutaneous nephrolithotomy

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