Approaches to Eliminate Radiation Exposure in the Management of Pediatric Urolithiasis

• Published in: Current urology reports Vol. 19; no. 10; p. 77
• Main Authors: Sahadev, Ravindra, Maxon, Victoria, Srinivasan, Arun
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.10.2018
• Subjects: Child; Critical Pathways; Fluoroscopy; Humans; Medicine; Medicine & Public Health; Nephrolithotomy, Percutaneous - methods; Nephrology; New Imaging Techniques (S Rais-Bahrami and K Porter; Radiation Exposure - prevention & control; Section Editors; Tomography, X-Ray Computed - adverse effects; Tomography, X-Ray Computed - trends; Topical Collection on New Imaging Techniques; Ultrasonography; Ureteroscopy - methods; Urolithiasis - diagnostic imaging; Urolithiasis - surgery; Urology; Radiation exposure; Fluoroscopy; Pediatric urolithiasis; Ureteroscopy; Ultrasound-guided; Percutaneous nephrolithotomy
• ISSN: 1527-2737; 1534-6285; 1534-6285
• DOI: 10.1007/s11934-018-0832-x

Purpose of Review Traditional management of pediatric urolithiasis has been associated with a significant amount of radiation exposure. The steady increase in pediatric urolithiasis in recent years has raised concerns of long-term consequences in this special population. This review seeks to highlight the newer insights towards eliminating radiation exposure in pediatric urolithiasis from contemporary literature. Recent Findings Establishing a clinical care pathway restricting usage of computed tomography in emergency rooms in suspected pediatric urolithiasis can eliminate unnecessary radiation exposure. Ultrasound can successfully replace fluoroscopy at ureteroscopy and percutaneous nephrolithotomy. Accredited technicians who use optimized settings combined with dose monitoring can significantly reduce fluoroscopic radiation. Summary Radiation exposure in pediatric urolithiasis can be significantly reduced and potentially eliminated by employing standard protocols during workup, intervention, and follow-ups. Larger studies can support the feasibility of routinely performing ultrasound-guided surgeries instead of fluoroscopy. There is a need for development of consensus towards standardization of the management of pediatric urolithiasis.