@article{3120669,
    title = "Imaging modalities and treatment of paediatric upper tract urolithiasis: A systematic review and update on behalf of the EAU urolithiasis guidelines panel",
    author = "Grivas, N. and Thomas, K. and Drake, T. and Donaldson, J. and Neisius, A. and Petřík, A. and Ruhayel, Y. and Seitz, C. and Türk, C. and Skolarikos, A.",
    journal = "Journal of Pediatric Urology",
    year = "2020",
    volume = "16",
    number = "5",
    pages = "612-624",
    publisher = "Elsevier Ireland Ltd",
    issn = "1477-5131",
    doi = "10.1016/j.jpurol.2020.07.003",
    keywords = "doxazosin;  gadolinium;  tamsulosin, child;  cystography;  diagnostic imaging;  extracorporeal shock wave lithotripsy;  female;  human;  laparoscopic surgery;  male;  nephrolithiasis;  nuclear magnetic resonance imaging;  open surgery;  percutaneous nephrolithotomy;  practice guideline;  preschool child;  priority journal;  renography;  retreatment;  Review;  school child;  sensitivity and specificity;  systematic review;  ureteroscopy;  urography;  urolithiasis",
    abstract = "Background: Prompt diagnosis and treatment of paediatric urolithiasis are required to avoid long term sequelae of renal damage. Objective: To systematically review the literature regarding the diagnostic imaging modalities and treatment approaches for paediatric urolithiasis. Study design: PubMed, Science Direct, Scopus and Web of Science were systematically searched from January 1980–January 2019. 76 full-text articles were included. Results: Ultrasound and Kidney-Ureter-Bladder radiography are the baseline diagnostic examinations. Non-contrast Computed Tomography (CT) is the second line choice with high sensitivity (97–100%) and specificity (96–100%). Magnetic Resonance Urography accounts only for 2% of pediatric stone imaging studies. Expectant management for single, asymptomatic lower pole renal stones is an acceptable initial approach, especially in patients with non-struvite, non-cystine stones<7 mm. Limited studies exist on medical expulsive therapy as off-label treatment. Extracorporeal shock wave lithotripsy (SWL) is the first-line treatment with overall stone free rates (SFRs) of 70–90%, retreatment rates 4–50% and complication rates up to 15%. Semi-rigid ureteroscopy is effective with SFRs of 81–98%, re-treatment rates of 6.3–10% and complication rates of 1.9–23%. Flexible ureteroscopy has shown SFRs of 76–100%, retreatment rates of 0–19% and complication rates of 0–28%. SFRs after first and second-look percutaneous nephrolithotomy (PNL) are 70.1–97.3% and 84.6–97.5%, respectively with an overall complication rate of 20%. Open surgery is seldom used, while laparoscopy is effective for stones refractory to SWL and PNL. Limited data exist for robot-assisted management. Conclusions: In the initial assessment of paediatric urolithiasis, US is recommended as first imaging modality, while non-contrast CT is the second option. SWL is recommended as first line treatment for renal stones <20 mm and for ureteral stones<10 mm. Ureteroscopy is a feasible alternative both for ureteral stones not amenable to SWL as well as for renal stones <20 mm (using flexible). PNL is recommended for renal stones >20 mm. © 2020 Journal of Pediatric Urology Company"
}