Children with spinal abnormalities have an increased health burden from upper tract urolithiasis.
OBJECTIVE
To examine the epidemiology and health care burden of upper tract urolithiasis in children with spinal abnormalities using a large, national database. Children with spinal dysraphism are predisposed to urolithiasis for many reasons, including immobility, bacteriuria, and urinary stasis. No large epidemiologic studies exist regarding stones in this specific group. Isolated spinal curvature may lead to hypercalciuria from immobility; however, urolithiasis rates are unknown.


METHODS
We extracted data from the Pediatric Health Information Systems database over an 8-year period. Hospitals reporting inpatient visits, emergency room visits, and ambulatory surgery visits were included. Using International Classification of Diseases, Ninth Revision codes and Current Procedural Terminology codes, we identified children with upper tract urolithiasis, spinal dysraphism, and spinal curvature. Data regarding demographics, prevalence, surgical procedures, costs related to stone procedures were extracted.


RESULTS
A total of 11,987 patients had urolithiasis. Prevalence of stones in patients with normal spines was 0.24% compared with 1.40% and 4.03% among children with spinal curvature and spinal dysraphism, respectively (P<.001). Children with spinal curvature and spinal dysraphism were more likely to have multiple procedures for stones than those without spinal abnormalities (25% vs 25.7% vs 13.1%, P<.001). Costs per patient were significantly higher for children with spinal abnormalities compared with those with normal spines.


CONCLUSIONS
Children with spinal curvature and spinal dysraphism have a much greater rate of upper tract urolithiasis, resulting in more procedures and related costs. Urolithiasis represents a significant, chronic health burden for children with spinal abnormalities. Screening and preventive care may reduce the impact of urolithiasis in these patients.
Division of Pediatric Urology, Children's Hospital Central California, Madera, CA. Electronic address: puneeta.ramachandra@gmail.com.
Puneeta
P
Ramachandra
Department of Urology, University of California San Diego School of Medicine, La Jolla, CA.
Kerrin L
KL
Palazzi
Department of Urology, University of California San Diego School of Medicine, La Jolla, CA; Department of Pediatric Urology, Rady Children's Hospital San Diego, San Diego, CA.
Nicholas M
NM
Holmes
Department of Urology, University of California San Diego School of Medicine, La Jolla, CA; Department of Pediatric Urology, Rady Children's Hospital San Diego, San Diego, CA.
George
G
Chiang
D000293:Adolescent; D000367:Age Factors; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D017281:Cost of Illness; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006776:Hospitals, Pediatric; D006801:Humans; D015994:Incidence; D038801:International Classification of Diseases; D007738:Kyphosis / Q000150:complications* / Q000175:diagnosis; D008297:Male; D012016:Reference Values; D012600:Scoliosis / Q000145:classification / Q000150:complications* / Q000175:diagnosis; D012720:Severity of Illness Index; D012737:Sex Factors; D016135:Spinal Dysraphism / Q000145:classification / Q000150:complications* / Q000175:diagnosis; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D052878:Urolithiasis / Q000145:classification / Q000209:etiology* / Q000628:therapy*