Lao M, Kogan BA, White MD, Feustel PJ
Urological Institute of Northeastern New York, Albany Medical College, Albany, New York

Abstract

PURPOSE: Pediatric urolithiasis has been treated with Shock Wave Lithotripsy, ureteroscopy, and percutaneous nephrolithotomy with high success rates during short-term follow-up. We studied our success rate and modifiable risk factors in patients with at least 5 years follow-up.

MATERIALS AND METHODS: Retrospective chart review was performed for patients < 18 who underwent upper tract stone surgery between 1999 and 2007, were stone free afterwards and had at least 5-year follow-up. Recurrence rate, anatomical and metabolic abnormalities were assessed.

RESULTS: Out of 60 eligible children, 30 (33 kidneys) had ≥ 5-year follow-up. The average age at surgery was 10 years, 17/30 were female and 20/33 kidneys had anatomical abnormalities. The overall recurrence rate within 5-years was 55% (95% CI 38-70%). Ureteral stones had a lower recurrence rate than renal stones (5/19 vs. 13/14, p <0.001). Patients with abnormal anatomy had a 65% (95% CI 43-82%) chance of reoccurring within 5-years vs. 38% (95% CI 18-65%) in those with normal anatomy; p=0.17. Out of the 18 reoccurrences, 10 required a second operation, 7 had abnormal anatomy, and 14/18 had calcium based stones. 24-hour urine testing in 13 children showed 10 with hypercalciuria and 11 with hypocitraturia; 9 had both.

CONCLUSIONS: We found a high recurrence rate in children with stones requiring surgical intervention, particularly in those with abnormal anatomy. This should be confirmed in a larger multicenter study of recurrence rates. In the meantime, our results suggest a need for aggressive diagnosis and treatment of metabolic abnormalities.

J Urol. 2013 Sep 16. pii: S0022-5347(13)05453-0. doi: 10.1016/j.juro.2013.09.021
PMID:24050895 [PubMed - as supplied by publisher]