Lao M et al, 2013: High Recurrence Rate at 5-Year Followup in Children after Upper Urinary Tract Stone Surgery
Lao M, Kogan BA, White MD, Feustel PJ
Urological Institute of Northeastern New York, Albany Medical College, Albany, New York
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]
A small low quality study on urolithiasis in children:
The authors state: "For patients to be included, they had to have been considered stone free" and at another part of the paper they say: "Interestingly, we demonstrated a difference in stone free rate based on the type of surgical approach."
A conclusion "SWL patients had a 71% and PCNL patients had a 100% recurrence rate" is based on the follow up of only 7 SWL and 7 PCNL treatments.
The authors defined hypocitraturia as 24‐hour citrate/creatinine ratio