ESPU-SPU Meeting on Saturday 25, September 2021, 15:15 - 15:57
Seha SAYGILI 1, Elif Altınay KIRLI 2, Emre TASDEMIR 3, Nur CANPOLAT 3, Salim CALISKAN 3, Lale SEVER 4, Zubeyr TALAT 2 and Bulent ONAL 2
1) Istanbul University-Cerrahpasa Cerrahpasa School of Medicine, PEDIATRICS DIVISION OF PEDIATRIC NEPHROLOGY, Istanbul, TURKEY - 2) Istanbul University-Cerrahpaşa Cerrahpaşa School of Medicine, Urology, Istanbul, TURKEY - 3) Istanbul University-Cerrahpaşa Cerrahpaşa School of Medicine, PEDIATRICS DIVISION OF PEDIATRIC NEPHROLOGY, Istanbul, TURKEY - 4) Istanbul University-Cerrahpaşa Cerrahpaşa School of Medicine, Pediatrics, Division of Pediatric Nephrology, Istanbul, TURKEY
We evaluated the risk factors for the requirement of surgical intervention in infants (≤ 12 months) with nephrolithiasis.
MATERIAL AND METHODS
Medical records of 122 infants (156 renal units (RUs)) were retrospectively reviewed. Demographic and clinical features, stone characteristics; metabolic and radiological evaluation, changes of stone status and treatment protocols were noted. The stone status of the RU was categorized into 3 groups according to change of size between first and last ultrasound as resolution, unchanged and growth.
Median age was 8 months (range:2-12). Median length of follow-up was 12 months (range:6-36). Majority of the patients (n=68,56%) were diagnosed incidentally. The resolution was detected in 94 RUs (60%). The stone growth was detected in 39 (25%) and stone size was unchanged in 23 RUs (15%). Surgical intervention required in 26 patients (17%). The history of ICU follow-up and stone size >5 mm at the time of diagnosis defined as independent risk factors for stone growth (p=0.012,0.002,respectively). The surgical intervention rate is higher in stones >5 mm and stones with pelvic localization (p=0.018, 0.021,respectively). Resolution is higher in patients with a stone size ≤5 mm (p=0.018). Regular use of medical treatment strongly related with resolution (p=0.006).
Medical treatment of metabolic disorder is remarkable factor associated with resolution. Stone size > 5mm at the time of diagnosis and history of ICU follow-up are the independed risk factors for stone growth. Pelvis localization of stone and stones > 5mm are associated with the increased risk of surgical intervention.
Lewis TAYLOR, Naima SMEULDERS, Navroop JOHAL and Alexander CHO
Great Ormond Street Hospital for Children, Paediatric Urology, London, UNITED KINGDOM
Our stone centre has seen a 63% increase in the number of new patients over two decades. In order to understand whether this reflects a change in the referral pattern or a true increase in the incidence of urolithiasis in childhood in England, we reviewed NHS England coding data: Hospital Episode Statistics(HES).
NHS England prospectively collects all admission data; HES data on diagnoses(ICD-10) and operations(OPCS-4) from 1999/2000-2018/2019 were summarised and analysed using linear regression. ‘Paediatric’ was defined as <15 years by HES. Any trend was corrected against aged-matched population change as recorded by Office for National Statistics(ONS).
There were 326 diagnoses in 1999/2000 rising to 459 in 2018/2019; a 13.7% increase by linear regression, predominantly due to increase in upper urinary tract calculi. Paediatric population growth was only 7% over the study period.
In terms of stone procedures, open operations have declined 98% by linear regression. The use of ESWL has declined 27%. PCNL was first recorded in 2000/2001 and increased steadily after 2005/2006, endoscopic procedures increased 45% with the biggest change in the last three years representing Retrograde Intra-Renal Surgery(RIRS).
In the last year, kidney stones were treated by open nephrolithotomy 0%, PCNL 22%, RIRS 39%, ESWL 39%. This compares to open nephrolithotomy 28%, PCNL 0%, RIRS 25%, ESWL 47% at the start of the century.
This study suggests a 7% increase in urolithiasis diagnoses in England for children aged <15yrs.
Aykut AKINCI 1, Murat Can KARABURUN 2, Eralp KUBILAY 2, Vahid Talha SOLAK 2, Adem SANCI 2, Tarkan SOYGUR 1 and Berk BURGU 1
1) Ankara University School of Medicine, Pediatric Urology, Ankara, TURKEY - 2) Ankara University School of Medicine, Urology, Ankara, TURKEY
Even in some endemic-urolithiasis-countries,routine vitaminD-prophylaxis is a health-policy.Effect of vitaminD-prophylaxis in terms of stone-recurrence in infants is'nt clearly known.In clinical practice,despite recommendations;there is a significant group of caregivers who discontinue vitaminD with concern for stone-recurrence.Aim of study is to evaluate,effect of vitaminD-prophylaxis in terms of stone-recurrence/growth in infants treated for urinary-tract-stones.
MATERIAL AND METHODS
Records between2010-19were retrospectively evaluated for urolithiasis patients-under-2 years;under VitaminD-prophylaxis before admission were retrospectively evaluated in 2seperate groups.First-group who required intervention;second-group who were conservatively followed-up.
Between2010-2019and who used routine vitaminD-prophylaxis before the application were included in study. Patients known to have organic stones such as cystine struvite uric acid were excluded from the study.
In group1 89patients who were stone-free,after-treatment were included.37of these stopped prophylaxis.
Group2 consisted,192patients with conservative follow-up where 81of stopped-vitaminD.
Patients;age/gender/family-history/previous-treatment/largest-stone-size were noted.
All patients;were evaluated by US/CT-scan at the 6th&12th-months follow-up for recurrence/growth.
ForGroup1 characteristics of subgroups regarding vitaminD continuation such as age(12,30±4,10months;11,04±4,71/(p 0,288)),
surgical-technique(p0.75)no statistical-difference was found.
In group continuing-vitamind-prophylaxis on the 6thmonth-ultrasound;17,3%microlithiasis;9,6% Stones(Larger-than-3mm)were seen.In group that doesn't continue;16,2%microlithiasis 8,1%stone was seen.(p0.95)
In group continuing-vitamind-prophylaxis on the 12thmonth-ultrasound;25%microlithiasis;11.5% stones were seen.(Larger-than-3mm).In group that doesn't continue;18.9% microlithiasis;10.8%stone was seen.(p 0.77)
Between the group that stops vitaminD-prophylaxis&ongoing-group in terms of
age(9,69 months±4,57; 10,26±4,67 months (p 0,37)),
gender(44m,37f;70m,41f (p 0.22)),
in terms of family-history(16%; 19,8% (P 0.50))
in terms of the largest-stone-size(5,94±2,02mm;6,17mm± 2,32 (p 0.59))
no statistical-difference was found.
While19.8%of patients required surgery in group who left vitaminD-prophylaxis;In ongoing-group,22.5%of surgery was required.There is no statistical-difference.(p0.64)
When evaluated in terms of stone-size change at the end of the 6thmonth,there was no difference between groups(stopped-vitaminD-prophylaxis;ongoing-group)(1,88mm;1,75mm/(p0,61)
When evaluated in terms of stone-size change at the end of the 12thmonth,there was no difference between groups(stopped-vitaminD-prophylaxis;ongoing-group)(2,36mm;2,55mm/(p0,60)
An important group of patients quit vitamind-prophylaxis,with concerns about kidney-stones.However vitamind-prophylaxis,didn't increase stone-recurrence,stone burden and need for surgery regardless of previously intervention/follow-up.
John JAYMAN 1, Hannah PROCK 1, Sweta CHALISE 2, Monica EPELMAN 3 and Pamela ELLSWORTH 4
1) Nemours Children's Hospital, Orlando, USA - 2) University of Central Florida College of Medicine, Orlando, USA - 3) Nemours Children's Hospital, Radiology, Orlando, USA - 4) Nemours Children's Hospital, Urology, Orlando, USA
The natural history of asymptomatic nephrolithiasis (AN) in children is not well defined and frequency of ultrasound evaluation not well established. Renal ultrasound studies are often obtained at 6-month intervals. The goal of this study is to evaluate the rate of stone progression and associated risk factors to determine optimal ultrasound interval.
MATERIAL AND METHODS
A retrospective IRB approved chart review was performed for patients seen for AN between 2012-2019. Patients with stone passage or stone procedure were excluded. Descriptive statistics were used for demographic information. A multivariable linear model was used to analyze risk factors. Statistical significance was set to p<0.05 a priori.
Thirty-three patients had 102 ultrasounds performed. The average age of diagnosis of AN was 11.8 years (SD±5.1). The average number of ultrasounds studies per patient was 3.1 (SD±1.5). The median time between follow-up ultrasounds was 7.2 months [IQR 0-19.1].
For the entire cohort, the change in largest stone size occurred at a rate of 0.084 mm/month or 0.504 mm/6 months. Patients with a renal anomaly had a three-fold increase in stone size compared to those without an anomaly (2.96 [CI 1.9-9.7], p=0.0046). Of those with a renal anomaly, 6 (54.5%) had hydronephrosis.
The small change in stone size over time favors a longer than 6-month interval for many children with AN. Our results suggest those with a renal anomaly, especially hydronephrosis, require more frequent follow-up.