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Patient and stone characteristics associated with surgical intervention in pediatrics
Esther Jun1, Peter Metcalfe1, Piush J Mandhane2
1Department of Surgery, The University of Alberta, Edmonton, AB T6G 1C9 Canada.
Insights
Larger kidney stones (over 6mm) and calcium oxalate composition predict the need for pediatric urolithiasis surgery. These factors help guide decisions on non-urgent surgical intervention for children.
Area of Science:
- Pediatric Urology
- Nephrology
- Surgical Decision Making
Background:
- Pediatric kidney stone (urolithiasis) incidence is rising.
- Limited data exists for non-urgent surgical intervention decisions in pediatric urolithiasis.
- Guidelines primarily focus on acute surgical management.
Purpose of the Study:
- Identify patient and stone characteristics predicting surgical intervention in children.
- Inform clinical decision-making for non-urgent pediatric urolithiasis management.
Main Methods:
- Retrospective chart review of 63 children (0-18 years) with 142 stones.
- Analysis of patient demographics, surgical history, metabolic measures, and stone characteristics (size, type, location).
- Univariate and multivariate analyses were performed to identify predictors of surgical intervention.
Main Results:
- 65% of children required surgery during a mean 19-month follow-up.
- Larger stone size (>6 mm) was significantly associated with surgical intervention.
- Calcium oxalate composition also predicted the need for surgery, independent of patient age or symptoms.
Conclusions:
- Stone size >6mm and calcium oxalate composition are key predictors for pediatric urolithiasis surgery.
- These findings aid in deciding between elective surgical management and observation for pediatric kidney stones.
- Study limitations include single-center, small sample size, and some missing data, though stone type remained significant.
Background:
The 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.
Objectives:
To identify patient and stone characteristics predicting stone surgery in children.
Design:
Retrospective chart review.
Setting:
Stollery Children's Hospital, Edmonton, Alberta, Canada from 1990 to 2013.
Patients:
Sixty-three children aged 0-18 years old who presented with a total of 142 stones.
Measurements:
Patient's surgical history, demographics, metabolic measures, and stone number, type, and location.
Methods:
Univariate 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.
Results:
Sixty-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.
Limitations:
Single 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.
Conclusion:
Stone 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.
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