Surgical Innovations Optimize Kidney Stone Care for Kids


In response to the rising incidence of stone disease in children, UCSF has launched the Pediatric Kidney Stone Clinic. Led by pediatric urologic surgeon Yi Li, MD, the clinic brings together a multidisciplinary team of pediatric nephrologists, including Farzana Perwad, MD, Onur Cil, MD, PhD, Kristen Favel, MD, MPH, and Christina Lo, MD, to provide comprehensive, tailored care for young patients with kidney stones.

Not only is the incidence of kidney stone disease increasing, but children who have stones now have higher rates of recurrence, according to Dr. Li. The cause of this growing frequency is unclear and is the subject of ongoing research, but it seems to be multifactorial and could involve dietary, hereditary, gut microbiome and environmental factors.

Dr. Perwad says, “Our clinical practice has a large population of children with kidney stones and unexplained diagnoses, especially those with rare metabolic syndromes, including cystinuria, primary hyperoxaluria and others, sometimes requiring stone surgery.” In many cases, kidney stones merely warrant close observation or medical management, Dr. Li notes. However, surgery is called for when patients experience recurrent infections, pain, obstruction or rapid growth of stones.

“Kids are not little adults,” says Dr. Li, “We need to consider other factors in our surgical approach, including radiation exposure, multiple anesthetics and pain control. The surgical approach for kids must be different than what we typically do for adults.”

Traditional Approaches to Complex Stone Surgery

Surgeons traditionally treat kidney stones via extracorporeal shock wave lithotripsy, ureteroscopy and percutaneous nephrolithotomy. Each offers benefits and drawbacks, many of which are amplified in children.

  • Extracorporeal shock wave lithotripsy uses sound waves to break up stones from outside the body. It involves no incisions and is an outpatient surgery; however, it does not work on harder stones, and the patient experiences pain when passing larger stone fragments.
  • Ureteroscopy involves inserting a thin, flexible scope through the urethra and bladder into the ureter to visualize and remove stones. It is also an outpatient surgery that does not require incision. However, it can prove difficult to access the kidneys of small patients. Therefore, they may need ureteral stents, which may require multiple surgeries and anesthesia exposures and can result in postoperative pain.
  • Percutaneous nephrolithotomy involves making a small incision in the back and inserting a scope directly into the kidney to remove stones. It is highly effective for removing stones and has better patient-reported outcomes for post-surgical discomfort. However, percutaneous nephrolithotomy is a higher-risk procedure that traditionally involves a large puncture of the kidney and an overnight stay in the hospital, as well as radiation exposure.

New Approaches to Optimizing Stone Surgery for Pediatric Patients

Dr. Li utilizes innovative surgical methods tailored for smaller anatomies and collaborates with nephrologists, dietitians, geneticists and other specialists to find answers for patients, families and referring providers. Dr. Li and his colleagues are keenly focused on adapting treatment to fit the scale of young patients. They employ innovative approaches to improve surgical outcomes, speed healing, minimize pain and reduce exposure to radiation, anesthesia and multiple procedures.

Dr. Li explains, “We’re doing something pretty unique with percutaneous nephrolithotomy (PCNL). We’re using ultrasound-guided access instead of radiation and making an ultra-mini-puncture, which is much smaller than the size of a pencil point, to decrease risk.”

He continues, “We’re using an approach I’m extremely excited about. We just purchased these very tiny scopes. They’re 7.5 French.” Utilizing these advanced techniques and minute-yet-mighty tools, Dr. Li and his team can precisely lase a stone and suction it out in just one procedure.

While many facilities are using PCNL, Dr. Li says very few offer ultrasound-guided ultra mini-PCNL. “In the Peninsula, we are leading the charge,” he says. The team recently treated a 23-month-old child using these techniques, and they have successfully treated seven cases since Dr. Li opened the clinic in September 2023.

The team also uses smaller scopes for ureteroscopy, eliminating the need for dilation, stents and multiple surgeries and anesthetics. And in most cases, they can clear numerous stones at once.

In addition to his focus on kidney stone disease, Dr. Li also specializes in using minimally invasive procedures to treat testicular developmental disorders, bladder, kidney and penile abnormalities, and congenital urological conditions.

Dr. Li sees patients at the Pediatric Kidney Stone Clinic in two locations – UCSF Benioff Children’s Hospital Redwood Shores Specialty Care Clinic in the Peninsula and UCSF Benioff Children’s Hospital San Francisco in Mission Bay. For referrals, call 877-UC-CHILD (877-822-4453).

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