Emphasizing that stone formation/occlusion can be observed in any part of the kidneys, ureters (thin urethra between kidney and bladder), bladder (urine bag) and urethra (external urinary tract), Op. Dr. Karagözoğlu noted that it can be viewed at any age, including children under one year old. On. Dr. Karagözoğlu also underlined that this disease can be without symptoms for a long time in some patients. Medical Point Gaziantep Hospital Pediatric Urology Specialist Op. Dr. Akın Karagözoğlu continued his words as follows:
“Having a family history of brick-in-brick disease in children indicates that genetic predisposition is effective. Urinary tract disease is a disease with a high risk of recurrence. For this reason, in order to prevent the formation of new stones and the growth of existing stones, it is necessary to seriously adjust fluid intake and dietary habits, and even to use some medications in the long term if the doctor considers it necessary. appropriate. Urinary tract stones differ in structure. Although we encounter stones containing calcium in 80 percent of cases, there are also stones with different structures (such as cystine stones, uric acid stones, infection stones). Knowing the type of stone causing the disease is important in determining our treatment methods. In the diagnosis of the disease, urinalysis, urine culture, biochemical analyzes of urine collected for 24 hours, some specific blood tests, physical analysis of the stone itself or part of it, if available, are performed.
Imaging studies such as x-rays, urinary tract ultrasound, and tomography may be scheduled on a patient basis to determine the location and size of the stone. In this way, the presence, number, location, component of the stone and the framing of the problem it causes are mapped. While some of these stones resolve spontaneously, with or without drug treatment, some require intervention. With the help of the development of technology, it can intervene in many ways in the urinary tract stones observed in the pediatric patient group. Thanks to these new methods, open surgery (surgery by cutting open the skin) has almost no place in the treatment of stone diseases.
The main ones are,
Stonebreaking with Out of Body Sound Wave (ESWL): It is mostly used in the treatment of kidney and ureter stones. It is done under sedation (light anesthesia). It is the process of breaking the stone into pieces where it is by focusing the sound waves sent from outside the body onto the stone.
After the procedure, these parts are expected to be excreted from the body with the urine stream. It may take more than one session to become completely stone-free. The success of the treatment depends on the hardness of the structure of the stone and thus on its strength against the sound wave.
Endoscopic procedures (URS, RIRS), a second method: It can be applied for stones throughout the urinary system.
General anesthesia and operating room conditions are required. It can be done by entering the urethra without creating an incision or access hole in the body. Using thin cameras and laser crushers, the stone is fragmented and poured out on its own, and in some appropriate cases, part of the stone is removed during surgery. Although the stone-free rate is high, the success rate may be low in patients with very narrow urinary tracts or at a very young age due to technical impossibility.
Finally, we resort to percutaneous interventions. This method is generally used for kidney and bladder stones. It is performed under general anesthesia and operating room conditions. The skin at the location of the stone is pierced with special tools to get to the stone, the stone is fragmented and removed in this way (PCNL). Stone-free rates are high. Due to evolving technology, the size of the drilled hole has decreased to millimeters (MiniPerc, MicroPerc) Due to the evolving capabilities, the success rates of surgical procedures in the pediatric age group have improved significantly. However, it should not be forgotten that the technique to be used should be given based on the experience of the urologist, the patient’s condition and the characteristics of the stone.
Kiss. Dr. Akın Karagözoğlu drew attention to the importance of determining the type of stone and preventing its recurrence, which is as important as surgery in treatment. For this purpose, Op. Dr. Karagözoğlu stated that in a hospital where all these problems cannot be planned, every treatment can be left unfinished.