Patient and Stone Characteristics Associated with Surgical Intervention in Pediatrics

Abstract

BackgroundThe incidence of kidney stones in children is increasing. While guidelines exist for acute surgical intervention, there is limited data to inform the decision as to when to intervene non-urgently.ObjectivesTo identify patient and stone characteristics predicting stone surgery in children.DesignRetrospective chart review.SettingStollery Children’s Hospital, Edmonton, Alberta, Canada from 1990 to 2013.PatientsSixty-three children aged 0–18 years old who presented with a total of 142 stones.MeasurementsPatient’s surgical history, demographics, metabolic measures, and stone number, type, and location.MethodsUnivariate and multivariate analysis, controlling for presentation number and individual-level variation by repeated measures analysis were conducted to assess for patient and stone characteristics associated with surgical intervention.ResultsSixty-five percent (41/63) required surgery during a mean follow-up of 19 months. Stone characteristics associated with surgical intervention by multivariate analysis included larger stone size (>6 mm), and stone composition of calcium oxalate.LimitationsSingle center study with a limited sample size and duration of follow up, thereby limiting predictive power. There were some missing data (i,e. stone type was not always available). Despite this, stone type remained significant in multivariate modeling.ConclusionStone size > 6mm and composition with calcium oxalate but not patient age or symptoms associated with presentation predicted surgical intervention. These observations can be used to inform decisions as to whether urolithiasis should be surgically managed electively or observed.Electronic supplementary materialThe online version of this article (doi:10.1186/s40697-015-0057-6) contains supplementary material, which is available to authorized users.

Urolithiasis in Children – A Health Problem of Civilization

“…The presence of stone in the urinary system does not mean a surgical treatment. [16]. It is considered that about 60-70% of stones are evacuated spontaneously.…”

“…Calcium phosphate stones were spontaneously evacuated in 78% of the patients, whereas 91% of the calcium oxalate stones required surgical treatment. The cystine and struvite stones usually require a surgical procedure because of their stability and big sizes [16].…”

Guidewire for Retrograde Passive Dilatation of Ureter in Pediatric Patients with Urolithiasis: A Novel Technique from a Tertiary Center in Nepal

“…However, due to delicate tissue and small caliber organ structure, management of ureteric stone in pediatric patient becomes harder compared to the adult [4]. Stones less than 3mm in size may pass spontaneously while the stones larger than 3mm need surgical management [5].…”

“…In the era of endourology, miniature semi-rigid ureterorenoscope (URS) (6/7.5Fr 5 0 ) with working channel 3mm is newer development in Urology [5]. However, this miniature scope is not applicable in pediatric patients due to virgin and undilated ureters.…”

Prevalence of urolithiasis among the Uyghur children of China: a population‐based cross‐sectional study

“…Paediatric urolithiasis is a painful and costly disease that can have detrimental and even life‐threatening effects on renal function . Children with stone sizes >6 mm require surgical intervention . The prevalence of paediatric urolithiasis varies remarkably between geographical regions and countries .…”