High recurrence rate at 5-year followup in children after upper urinary tract stone surgery.
OBJECTIVE
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.


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.
Urological Institute of Northeastern New York, Albany Medical College, Albany, New York.
Michael
M
Lao
Urological Institute of Northeastern New York, Albany Medical College, Albany, New York. Electronic address: koganb@mail.amc.edu.
Barry A
BA
Kogan
Urological Institute of Northeastern New York, Albany Medical College, Albany, New York.
Mark D
MD
White
Urological Institute of Northeastern New York, Albany Medical College, Albany, New York.
Paul J
PJ
Feustel
D002648:Child; D002951:Citrates / Q000652:urine; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006869:Hydronephrosis / Q000453:epidemiology; D053565:Hypercalciuria / Q000209:etiology; D008297:Male; D012008:Recurrence; D012086:Reoperation; D014514:Ureteral Calculi / Q000473:pathology / Q000601:surgery; D001750:Urinary Bladder, Neurogenic / Q000453:epidemiology; D052878:Urolithiasis / Q000473:pathology / Q000601:surgery*; D014718:Vesico-Ureteral Reflux / Q000453:epidemiology
D002951:Citrates
KUB; PCNL; SWL; URS; hypercalciuria; pediatrics; percutaneous nephrolithotomy; recurrence; shock wave lithotripsy; ureteroscopy; urolithiasis; x-ray of kidneys, ureters and bladder