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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Dr. Moritz Hamann
Klinik für Urologie und Kinderurologie, Universitätsklinikum Schleswig-Holstein, Campus
Kiel
Arnold-Heller-Straße 7
24105 Kiel
eMail: mhamann@urology.uni-kiel.de
