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Unlike adults, children must have their stones removed, Steven Docimo says.
Unlike adults, children must have their stones removed, Steven Docimo says.


Kidney Stones in Children Are More Problematic

idney and bladder stones are much rarer in children than in adults,” says pediatric urologist Steven G. Docimo, M.D., “and they’re also frequently linked with an underlying anatomical abnormality such as spina bifida, a reconstructed urinary tract or augmented bladder. That means there’s not as much experience in dealing with the problem, he says, and that treatment can be complicated.

“Children with altered anatomy tend to make stones because of pooling of urine or infection,” Docimo explains. They may be unaware that they have stones—the problem’s often picked up during routine ultrasound screening. Unlike adults, young people usually must have stones removed, “even when a child is asymptomatic,” says Docimo. “Odds are that the stones will eventually cause trouble, growing to obstruct the kidney.”

Treatment at Hopkins is variable. For kidney stones, extracorporeal shock wave lithotripsy forms the first approach, Docimo says. But for resistant stones, Hopkins also offers the percutaneous therapy common for adults. Such treatment is unusual in children because of size and delicacy constraints. But the team Docimo works with at the Brady Urological Institute has developed a small surgical instrument that permits the process, saving children the risks of more involved surgery. With the help of Sally Mitchell, M.D., and the other interventional radiologists here, Docimo first inserts a nephrostomy tube and then a plastic sheath into the child’s kidney. The sheath allows access of a nephroscope. Once the stone is sighted, other instruments—either a laser or miniaturized lithotripter—can break it up. The sheath Docimo uses is one he’s designed to be far smaller than available adult versions. “It lets us do the procedure with very little dilation of the kidney and leaves almost no scar,” he says, “while still allowing access to the entire kidney.”