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Ellison JS et al, 2018: Risk factors for repeat surgical intervention in pediatric nephrolithiasis: A Pediatric Health Information System database study.

Ellison JS, Shnorhavorian M, Oron A, Kieran K, Lendvay TS, Merguerian PA.
Pediatric Urology, Seattle Children's Hospital, University of Washington, Seattle, WA, USA.

Abstract

INTRODUCTION: Successful surgical therapy for pediatric upper urinary tract calculi (UUTC) minimizes the need for repeat surgical interventions. However, staged procedures, whether planned or unplanned, are sometimes necessary. We assessed predictors of repeat intervention for children with UUTC using a nationwide administrative dataset.
METHODS: Using the Pediatric Health Information System (PHIS) dataset, we assessed children with UUTC undergoing shock wave lithotripsy (SWL) or ureteroscopy (URS) for an index stone from January 2010 to June 2015. Primary outcome was additional treatment for nephrolithiasis within 90 days. Patient and procedural variables were assessed as potential risks for retreatment. Multivariable logistic regression models were used to compare the risk of retreatment adjusting for potential confounding factors.
RESULTS: A total of 2788 patients undergoing URS (2,216, 79.5%) and SWL (572, 20.5%) were identified. SWL, stenting at the index operation without pre-index stenting, chronic comorbidities, renal calculi, and age <5 years were independent risk factors for retreatment. Use of ureteral stenting, most commonly employed in URS, was also a strong predictor of retreatment. Odds for reintervention, adjusted by multivariate modeling, are shown in the Figure.
CONCLUSIONS: Adjusting for measured confounders, SWL is associated with a 2.6-fold higher risk of repeat stone-related interventions. Additional patient-related factors also increase likelihood of retreatment. Intra-operative stent placement is a strong predictor of retreatment, perhaps serving as a marker for complex cases or planned staged procedures. Prospective studies are needed to assess comparative effectiveness of SWL and URS and improve mono-therapeutic success for children with UUTC.

Ellison JS

J Pediatr Urol. 2018 Mar 16. pii: S1477-5131(18)30109-8. doi: 10.1016/j.jpurol.2018.02.017. [Epub ahead of print]

 

 

 

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Comments 1

Peter Alken on Friday, 13 July 2018 08:18

This is a very detailed care research analysis. it would be good to have similar data on all other stone treatment procedures in all age groups.
Preoperative and intraoperative stenting and postoperative stent removal in a child can mean three anaesthesia sessions. The analysis focussed on secondary procedures for stone removal only. “Exposure to repeated anesthetics in the setting of pre-stenting or stent removals is a valuable consideration for defining care strategies in the pediatric population, these analyses were beyond the scope of our current study design.”

The stent ptroblem is a detail not completely shown in the abstract but in the text: “Stent-placement at the time of operation was the strongest risk factor for retreatment and suggests a proportion of children undergoing planned staged treatments” and “To evaluate the association of ureteral stenting and treatment success across modalities, the most common URS treatment modality (index stenting and no pre-index stenting, 1179 cases) was compared with the most common SWL modality (no stenting, 382 cases). In this comparison, ORs for retreatment were significantly lower for un-stented SWL than URS (OR 0.49, 95% CI 0.33-0.73). Meanwhile, the odds of retreatment with URS involving both pre-index and index stenting (558 cases) are similar to un-stented SWL (OR 1.2, 95% CI 0.56-1.34).

Complications, though not given in details, at the time of initial procedure, were more frequent in the URS group (7.5%) compared with SWL (4.2%), p

This is a very detailed care research analysis. it would be good to have similar data on all other stone treatment procedures in all age groups. Preoperative and intraoperative stenting and postoperative stent removal in a child can mean three anaesthesia sessions. The analysis focussed on secondary procedures for stone removal only. “Exposure to repeated anesthetics in the setting of pre-stenting or stent removals is a valuable consideration for defining care strategies in the pediatric population, these analyses were beyond the scope of our current study design.” The stent ptroblem is a detail not completely shown in the abstract but in the text: “Stent-placement at the time of operation was the strongest risk factor for retreatment and suggests a proportion of children undergoing planned staged treatments” and “To evaluate the association of ureteral stenting and treatment success across modalities, the most common URS treatment modality (index stenting and no pre-index stenting, 1179 cases) was compared with the most common SWL modality (no stenting, 382 cases). In this comparison, ORs for retreatment were significantly lower for un-stented SWL than URS (OR 0.49, 95% CI 0.33-0.73). Meanwhile, the odds of retreatment with URS involving both pre-index and index stenting (558 cases) are similar to un-stented SWL (OR 1.2, 95% CI 0.56-1.34). Complications, though not given in details, at the time of initial procedure, were more frequent in the URS group (7.5%) compared with SWL (4.2%), p
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