Management of pediatric urolithiasis induced by melamine-contaminated powdered formula (report of 619 cases).

摘要

OBJECTIVE: To investigate the clinical features and therapeutic efficacy in children with urolithiasis caused by ingestion of melamine-contaminated powdered formula. METHODS: The clinical presentation, laboratory data, ultrasound findings, and treatment methods used for 619 children with melamine-induced urolithiasis were retrospectively recorded and analyzed. The efficacy of the treatment in these children was summarized and evaluated. RESULTS: A total of 619 children aged 1-88 months were included in the present study (mean age 16.32 months). The male/female ratio was 1.9:1. Of the 619 patients, 577 received conservative treatment and 454 became stone free (78.7%). Of the 151 patients with renal and/or ureteral stones, 1-6 sessions of extracorporeal shock wave lithotripsy were performed in 81 patients (61 successful [35.5%] of 172 sessions) and retrograde ureteral catheterization in 70 patients (56 successfully treated [80.0%]). In centers without expertise in minimally invasive medical techniques, 5 patients with bilateral obstructive renal failure were successfully treated with ureteral lithectomy (n = 4) and percutaneous nephrostomy (n = 1). For the remaining 27 children with refractory renal or ureter stones, 9 were successfully treated with percutaneous nephrolithotomy and 18 children underwent ureteroscopic lithotripsy to become stone free. A total of 22 bladder and/or urethral stones were successfully treated with cystoscopic lithotripsy. CONCLUSIONS: Most children with melamine-induced urolithiasis were treated successfully with an infusion of fluids, urine basification, and diuresis. Extracorporeal shock wave lithotripsy is a safe and effective technique for patients in whom conservative treatment fails. However, for patients who have presented with obstructive renal failure, surgical intervention should be considered as early as possible to relieve the obstruction.