Pediatric Stone Center | Treatments and Services

 

Dr. Devarajan.

“Kidney stones are largely preventable and treatable. And the majority of children with recurring stones can be effectively treated with simple measures.” 

Prasad Devarajan, MD
Director, Division of Nephrology and Hypertension; Medical Director, Stone Center
 − WHY CHOOSE CINCINNATI CHILDREN’S

Treatment Options for Stone Conditions

The Stone Center uses two main approaches to treating your child’s condition – medical and surgical management.  Your doctors will work together and with you to decide what is best for your child. 

Medical Management

The treatment for urinary tract stones in children depends on the size of the stone, the location of the stone, composition of the stone, amount of pain the stone is causing, and whether the stone is blocking any portion of the urinary tract.

Your child may require pain medication, depending on the severity of the pain.

Your child may be encouraged to increase fluid intake to aid in passing the stone through the urinary tract, or your child may require IV fluids if he or she is unable to drink.

Other common medications prescribed may include diuretics (water pills) and citrate supplements.

Patient and family education is individualized based on family history and risk for stone formation. Providing information about diet, medication and exercise to prevent stones is key to minimizing recurrent stone formation and maximizing kidney function.

Care is provided on an individualized basis.  Children with stones may have other complex medical conditions.  Our Stone Center team has the ability to consult with other pediatric medical specialties such as cardiology, pulmonology and neurology to meet the specialized needs of your child.

Surgical Management

Surgical treatment may be considered if your child has a larger stone in the urinary tract that is blocking urine flow and/or causing a large amount of pain.  Our team of pediatric urology surgeons and pediatric anesthesiologists work collaboratively to provide the best surgical outcome.  Procedures that may be considered include:

ESWL (extracorporeal shock wave lithotripsy) is a procedure that uses outside energy to break up the stone. No incision (cut in the skin) is needed. Before the procedure, a moving X-ray locates the stone, and then the energy waves crush the stone into very small pieces. The small stone pieces pass when the child urinates.

Patients usually go home the same day of the procedure and return to normal activities in one to three days. Your child should not be involved in vigorous physical activity if a ureteral stent is placed to help the stone fragments pass.

This treatment involves use of a small telescope (ureteroscope) to access stones in the ureter (tube that goes from the bladder to the kidney) or kidney. No cut in the skin is needed since the scope enters at the urethra (opening which allows urine to exit body), proceeds to the bladder and the ureter.

When the stone is seen it can be removed with a basket-like tool. If the stone is large, a laser can be used to break it into very small pieces. 

A ureteral stent may be placed after the ESWL or ureteroscopy procedures. It may also be placed without any other procedure, to assist the stone to pass down the ureter.

The stent is a thin, flexible tube that extends from the kidney to the bladder. It prevents blockage of urine due to swelling or buildup of stone fragments. The stent cannot be seen from outside the body.

Contact sports and physically strenuous activities must be avoided.

The child may feel some discomfort, and feel the urge to urinate often. The urine may appear pink or red. These symptoms will disappear when the stent is removed several weeks later.

Antibiotics and a medication to stop bladder spasms (from irritation of the bladder wall by the stent) will be prescribed. 

Percutaneous nephrolithotomy is used when a very large stone is located in the kidney or when other treatments fail. A small cut is made in the lower back and a small telescope is inserted into the kidney. Once seen, the stone can be broken into smaller pieces and removed.

Nephrostomy Tube Procedure

A nephrostomy tube is a small, flexible, rubber tube that is surgically inserted through the skin into the kidney to drain urine. The urine collects in a bag outside the body. 

This procedure may be needed to prevent kidney damage and infection if something, such as a kidney stone, is blocking normal urine drainage through the ureter (tube connecting kidney to bladder).

Nephrostomy tubes are placed by specialists in the interventional radiology department, using general anesthesia. The procedure takes about an hour.

After the procedure, discomfort is usually mild and will be treated with pain medication. Once we are sure the tube is draining properly, your child may be discharged. A nurse will teach you how to take care of the tube at home.

Once the kidney stone or other blockage has been taken care of and the tube is no longer needed, it will be removed.