There is a wide
misconception that only adults develop stones. On the contrary kidney
stones are very common in children living in hot climates.
is a stone formed in urine?
Urine is basically made of unwanted salts in the body. Presence
of a reasonable amount of water is essential to prevent stone formation.
When the the water content is less, the urine becomes concentrated
and favours stone formation. Also stagnation to urine flow promotes
stone formation. Some children with stones have birth defects that
make them pass more calcium and less citrate in urine. Children
with recurrent urine infection are more prone to develop stones;
stone in turn promotes urine infection.
What are the symptoms
of urine stones?
• There can be no symptoms when a stone is present.
• When a stone is blocking urine passage in the kidney or
urinary tubes, severe loin pain results
• When there is a stone in the urinary bladder, there will
be pain at lower part of belly or the penis.
• Pain when passing urine, blood in urine or even passing
small stones or gravel can be present.
• Small babies can’t tell these. When children cry while
passing urine or when there is urine infection, it is
essential to rule out a stone.
How is a stone detected?
When children experience the above symptoms, urine is tested in
the lab. Presence of excess red cells or white cells; and presence
of crystals in the urine suggests urinary stone disease. Ultrasound
scan helps to find out whether there is a stone, the position, size
and number of stones. In addition special tests like IVP, X-Ray,
or CT scan may be required.
What are the treatments
available to remove the stones?
There is a general misconception that childhood stones always require
open surgery. Like adults children also can be treated without open
surgery. In modern medicine facilities are available to break stones
and 80% are removed without open surgery. For this it is essential
to consult a pediatric urologist trained in this field.
When stone is present in the bladder, it can be removed with the
help of an endoscope. Endoscope is a small tube with a camera that
is passed up via the urinary passage. The stones are grasped with
small grabbers. Bigger stones can be broken with the help of a technique
called lithotripsy. As children won’t stay still, they need
a general anesthesia. To prevent blockage by broken stone pieces,
a small tube called stent is left in for 2-3 weeks.
A technique called ESWL uses sound waves to break stone. With the
help of an x-ray or a scan the stone is focused. ESWL machine breaks
the stone in less than an hour. Sometimes a second sitting may be
required for complete stone clearance. With this treatment, children
can return home with a couple of days. Small children need general
anesthesia, as they have to lay still for this.
Can stones come back?
How can we prevent this?
Children have a 20-50% higher chance for the stone recurrence. Problems
like passing excess calcium in urine can be there. It is essential
to identify this to prevent further stone formation. Regular toileting
and drinking plenty of water are essential to prevent stones and
What are the dietary restrictions in children
• In general drinking plenty of water (10-20 cups) helps to
reduce stone formation.
• Salt should be restricted in diet.
• Non vegetarian foods and milk products need to be reduced.
• Cabbage, spinach, cashew, walnut etc need to be avoided.
• Coffee, tea, cola, apple and grape juices need to be restricted.
• Orange and lime juices are good.
• Vitamin D and calcium tonics should be avoided.
• Like adults children can also develop urinary stones.
• Children can have underlying medical problems that make
them prone to develop stones.
• It is essential to identify and treat these to prevent stone
• With the advent of newer facilities, 80% of stones in children
can be removed without open surgery.
• It is essential to consult a paediatric urologist trained
in this area to obtain the appropriate treatment.