High recurrence rate at 5-year followup in children after upper urinary tract stone surgery
Michael Lao1, Barry A Kogan1, Mark D White1
1Urological Institute of Northeastern New York, Albany Medical College, Albany, New York.
Insights
Pediatric urolithiasis recurrence is high after surgery, especially in children with anatomical abnormalities. Aggressive diagnosis and treatment of metabolic issues are recommended to manage stone recurrence in children.
Area of Science:
- Pediatric Urology
- Nephrology
- Surgical Outcomes
Background:
- Pediatric urolithiasis treatments like shock wave lithotripsy, ureteroscopy, and percutaneous nephrolithotomy show short-term success.
- Long-term outcomes and recurrence factors in pediatric stone disease require further investigation.
Purpose of the Study:
- To evaluate the long-term success rate of pediatric upper tract stone surgery.
- To identify modifiable risk factors for stone recurrence in children after surgical intervention.
Main Methods:
- Retrospective chart review of patients under 18 who had upper tract stone surgery (1999-2007).
- Analysis included stone recurrence rates, anatomical abnormalities, and metabolic assessments at least 5 years postoperatively.
Main Results:
- A 55% recurrence rate was observed within 5 years in the studied pediatric cohort.
- Abnormal renal anatomy (65% recurrence) and ureteral stones (lower recurrence) were significant factors.
- Metabolic abnormalities like hypercalciuria and hypocitraturia were prevalent in recurrent cases.
Conclusions:
- Children undergoing surgical treatment for urolithiasis face a high risk of recurrence, particularly those with anatomical abnormalities.
- Early and aggressive diagnosis and management of metabolic derangements are crucial.
- Further multicenter studies are needed to confirm these recurrence rates.
Purpose:
Pediatric urolithiasis has been treated with shock wave lithotripsy, ureteroscopy and percutaneous nephrolithotomy with high success rates during short-term followup. We studied our success rate and modifiable risk factors in patients with at least 5 years of followup postoperatively.
Materials And Methods:
Retrospective chart review was performed for patients younger than 18 years who underwent upper tract stone surgery between 1999 and 2007, were stone-free afterward and had at least 5 years of followup. Recurrence rate, and anatomical and metabolic abnormalities were assessed.
Results:
Of 60 eligible children 30 (33 kidneys) had at least 5 years of followup. Average patient age at surgery was 10 years, 17 patients were female and 20 kidneys had anatomical abnormalities. Overall recurrence rate at 5 years was 55% (95% CI 38%-70%). Ureteral stones had a lower recurrence rate than renal stones (5 of 19 and 13 of 14, respectively, p <0.001). Patients with abnormal anatomy had a 65% (95% CI 43%-82%) chance of recurrence within 5 years vs 38% (95% CI 18%-65%) in those with normal anatomy (p = 0.17). Of the 18 recurrences 10 required a second operation, 7 demonstrated abnormal anatomy and 14 involved calcium based stones. A 24-hour urine test in 13 children revealed 10 with hypercalciuria and 11 with hypocitraturia, with 9 patients exhibiting both conditions.
Conclusions:
We found a high recurrence rate in children with stones requiring surgical intervention, particularly those with abnormal anatomy. This finding 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.
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