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Gabrigna Berto F. et al., 2023:A population-based retrospective cohort study of surgical trends and outcomes of pediatric urolithiasis in Ontario, Canada (2002-2019).

Gabrigna Berto F, Wang P, McClure JA, Bjazevic J, Golomb D, Filler G, Diaz-Gonzalez de Ferris M, Welk B, Razvi H, Dave S.
Department of Surgery, Division of Urology, Western University, London, Ontario, Canada.
Department of Surgery, Division of Urology, Western University, London, Ontario, Canada; Division of Pediatric Surgery and Division of Urology, Western University, London, Ontario, Canada.
Department of Surgery, London Health Sciences Centre, London, Ontario, Canada.
Urology Department, Assuta Ashdod Hospital, Ashdod, Israel.
Department of Pediatrics, Division of Pediatric Nephrology, Western University, London, Ontario, Canada.
Department of Pediatrics, University of North Carolina, Chapel Hill, NC, USA.
Department of Surgery, Division of Urology, Western University, London, Ontario, Canada; Division of Pediatric Surgery and Division of Urology, Western University, London, Ontario, Canada.

Abstract

Introduction: The worldwide incidence of pediatric urinary stone disease (PUSD) is increasing. However, there is no commensurate data on whether this translates to an increasing need for surgical intervention for PUSD, given the role of conservative management.

Objective: We aimed to evaluate the trends and outcomes of clinically significant PUSD, using administrative databases to identify patients surgically treated for PUSD.

Study design: This retrospective population-based cohort study assessed the incidence and trends of surgically treated PUSD and outcomes in Ontario, Canada in patients <18 years of age who underwent their first PUSD procedure between 2002 and 2019 utilizing administrative databases held at the Institute of Clinical Evaluative Sciences (ICES). We assessed the incidence of surgically treated PUSD, demographics, initial surgical treatment and imaging modality, and risk factors for repeat intervention within 5 years. Statistical analyses summarized demographics, surgical trends, and logistic regression was used to identify risk factors for repeat surgical intervention.

Results: We identified 1149 patients (mean age 11.3 years), with 59.6% older than 12 years. There was a decrease in the number of PUSD procedures performed per year that was close to statistical significance (p = 0.059) and a trend towards increased utilization of ureteroscopy (URS) compared with Shockwave Lithotripsy (SWL). In addition, there was a significant increase in the proportion of females surgically treated with PUSD (p = 0.001). In the 706 patients followed for 5 years, 17.7% underwent a repeat procedure within 6 months, while 20.4% underwent a repeat procedure from 6-months to 5 years. Renal stone location (OR 2.79, 95% confidence interval (CI) 1.62-4.80, p = 0.0002) and index SWL (OR 1.66, 95% CI 1.20-2.31, p = 0.0025) were risk factors for repeat surgical intervention within the first 6-months. There was an increasing utilization of ultrasound (US) compared to computerized tomography (CT) (p = 0.0008).

Discussion: Despite the literature reporting increasing PUSD incidence, we observed a non-significant decrease in the number of surgical PUSD procedures performed. Exclusion of those treated conservatively may explain our results. The increase in the proportion of females treated reflects the narrowing gender gap in stone disease. A trend towards increased URS utilization was observed and re-intervention rates were similar to previous studies.

Conclusion: The overall rate of surgically treated PUSD did not show an increasing trend in Ontario, Canada from 2002 to 2019. URS was the most common surgical treatment modality, with a corresponding decline in SWL rates. PUSD was associated with a high surgical re-intervention rate within 6 months.

J Pediatr Urol. 2023 Dec;19(6):784-791. doi: 10.1016/j.jpurol.2023.08.035. Epub 2023 Sep 9. PMID: 37739819

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Comments 1

Peter Alken on Friday, 17 May 2024 11:00

This is one of the few papers that does not show a significant increase in the number of procedures performed for stone removal which is disproportional to the lower incident increase of urolithiasis like e.g. a 48% or even nearly 100% (1, 2) procedure increase in 2 decades (1, 2).
It is not only the type of procedure selected by the surgeon (3) but also the indication as such. The patient seems to have only one task: to present a stone to the urologist (4) which is a bad cooperation.

1 Ordon M, et al. A population based study of the changing demographics of patients undergoing definitive treatment for kidney stone disease. J Urol. 2015 Mar;193(3):869-74. doi: 10.1016/j.juro.2014.09.096.

2 Golomb D, et al. A retrospective cohort study, analyzing trends in management of upper urinary tract stones in the adult Israeli population.
Urologia. 2023 Sep 30:3915603231203430. doi: 10.1177/03915603231203430.

3 Pietropaolo A, et al.
Worldwide trends of practice and intervention in paediatric endourology: comparison of European versus Non-European responses.
Cent European J Urol. 2023;76(3):245-250. doi: 10.5173/ceju.2023.79

4 Pauchard F, et al. Patient's preferences: an unmet need by current urolithiasis guidelines: a systematic review. World J Urol. 2023 Dec;41(12):3807-3815. doi: 10.1007/s00345-023-04678-4.

Peter Alken

This is one of the few papers that does not show a significant increase in the number of procedures performed for stone removal which is disproportional to the lower incident increase of urolithiasis like e.g. a 48% or even nearly 100% (1, 2) procedure increase in 2 decades (1, 2). It is not only the type of procedure selected by the surgeon (3) but also the indication as such. The patient seems to have only one task: to present a stone to the urologist (4) which is a bad cooperation. 1 Ordon M, et al. A population based study of the changing demographics of patients undergoing definitive treatment for kidney stone disease. J Urol. 2015 Mar;193(3):869-74. doi: 10.1016/j.juro.2014.09.096. 2 Golomb D, et al. A retrospective cohort study, analyzing trends in management of upper urinary tract stones in the adult Israeli population. Urologia. 2023 Sep 30:3915603231203430. doi: 10.1177/03915603231203430. 3 Pietropaolo A, et al. Worldwide trends of practice and intervention in paediatric endourology: comparison of European versus Non-European responses. Cent European J Urol. 2023;76(3):245-250. doi: 10.5173/ceju.2023.79 4 Pauchard F, et al. Patient's preferences: an unmet need by current urolithiasis guidelines: a systematic review. World J Urol. 2023 Dec;41(12):3807-3815. doi: 10.1007/s00345-023-04678-4. Peter Alken
Friday, 12 July 2024