5th Joint Meeting of ESPU-SPU - Virtual

S22: STONES 1 (parallel session, room 2)

Moderators: Berk Burgu (Turkey)

ESPU-SPU Meeting on Saturday 25, September 2021, 15:15 - 15:57


15:15 - 15:18
S22-1 (PP)

INFANTILE NEPHROLITHIASIS-WHAT ARE THE PREDICTORS OF SURGICAL INTERVENTION?

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

PURPOSE

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. 

RESULTS

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).

CONCLUSIONS

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. 


15:18 - 15:21
S22-2 (PP)

INCIDENCE OF PAEDIATRIC URINARY TRACT CALCULI IN ENGLAND FROM 1999 - 2019

Lewis TAYLOR, Naima SMEULDERS, Navroop JOHAL and Alexander CHO
Great Ormond Street Hospital for Children, Paediatric Urology, London, UNITED KINGDOM

INTRODUCTION

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).

METHODS

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).

RESULTS

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.

CONCLUSIONS

This study suggests a 7% increase in urolithiasis diagnoses in England for children aged <15yrs.


15:21 - 15:24
S22-3 (PP)

TWINKLE, TWINKLE...IS IT A STONE?

Alexandra REHFUSS 1, Kathleen PUTTMANN 2, Molly FUCHS 1, Daryl MCLEOD 1, Christina CHING 1, Seth ALPERT 1, Rama JAYANTHI 1 and Daniel DAJUSTA 1
1) Nationwide Children's Hospital, Urology, Columbus, USA - 2) Ohio State University Wexner Medical Center, Urology, Columbus, USA

PURPOSE

Color doppler ultrasound (CDU) detects nephrolithiasis by the presence of an echogenic focus, posterior acoustic shadowing and/or twinkle artifact (TA). TA has been shown to be highly predictive of nephrolithiasis in adults with renal colic and ureteral stones. We sought to evaluate if TA is reliable for diagnosing nephrolithiasis in the pediatric population.

MATERIAL AND METHODS

We reviewed renal CDU reports indicating presence or absence of TA associated with a single echogenic focus in the kidney or ureter. Patients <18 years old were included. Stone was confirmed by CT within 3 months of the CDU, visualization on ureteroscopy or patient report of passing stone.

RESULTS

Nephrolithiasis was diagnosed using TA on 223 CDUs. Mean age was 8.5 years (range 0.1-17.9); 118 patients were male (53%). TA was most commonly identified in the kidney (n=208, 93%). Confirmatory studies were available for 66 CDUs (30%), and TA was confirmed to be a stone in 49 cases(74%). Majority of confirmed stones were in the kidney (n=40; 82%) and mean size on CDU was 5mm(range 1.5-10). Sensitivity, specificity, positive predictive value and negative predictive value of TA for detecting nephrolithiasis was 83%, 78%, 74% and 86% respectively.

CONCLUSIONS

Compared to the adult literature, TA in children has lower sensitivity, specificity and positive predictive value, but similar negative predictive value for diagnosing nephrolithiasis. This may be related to renal location and smaller stone size. The presence of TA should be weighed in the setting of other clinical evidence of nephrolithiasis.


15:24 - 15:33
Discussion
 

15:33 - 15:36
S22-4 (PP)

URINARY STONE IN INFANTS; SHOULD VITAMIN D PROPHYLAXIS BE STOPPED IN ENDEMIC COUNTRIES?

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

PURPOSE

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.

RESULTS

ForGroup1 characteristics of subgroups regarding vitaminD continuation such as age(12,30±4,10months;11,04±4,71/(p 0,288)),
gender(28m,9f;34m,18f),
family-history(18.9%;15.4%(p 0.66)))
preoperative-stone-size(11.19±4,16mm;11.81±4,20mm(p0.29))
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)

Forgroup2;
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)

CONCLUSIONS

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.


15:36 - 15:39
S22-5 (PP)

ASYMPTOMATIC NEPHROLITHIASIS IN CHILDREN: HOW OFTEN SHOULD PATIENTS RECEIVE FOLLOW-UP ULTRASOUND IMAGING?

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

PURPOSE

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.

RESULTS

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.

CONCLUSIONS

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.


15:39 - 15:42
S22-6 (PP)

IMPACT OF BMI ON ENDOUROLOGICAL SURGERY OUTCOMES OF PEDIATRIC UPPER URINARY TRACT CALCULI AND ITS CORRELATION WITH STONE COMPOSITION

Yu ZHANG 1, Jun LI 2 and Ye TIAN 2
1) Beijing Friendship Hospital, Capital Medical University, Department of Urology, Beijing, CHINA - 2) Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China, Department of Urology, Beijing, CHINA

PURPOSE

To assess the impact of BMI on endourological outcomes of pediatric upper urinary tract calculi and discuss the difference of stone components under different BMI.

MATERIAL AND METHODS

A prospectively managed database containing 348 children who were diagnosed with upper urinary tract calculi and treated with endourological surgery was analyzed from June 2014 to April 2019. BMI of the pediatric patients were calculated and plotted them on the Centers for Disease Control and Prevention (CDC) growth chart for gender and age to estimate the BMI status. 110 of the 348 children were performed stone composition analysis by Fourier transform infrared spectroscopy.

RESULTS

The SFR of obese or overweight children, normal children and underweight children were 87% (141/162) , 87.2% (137/157) and 92.6% (52/56), respectively. There was no statistical difference in SFR among the three groups (P= 0.78). And the CR of obese or overweight children, normal children and underweight children were 17.9% (29/162), 38.2% (60/157), 50.0% (28/56), respectively. The difference had statistical significance (P< 0.05). Multivariate analyses showed that BMI status represented predictors of CR. As for infectious stones, struvite and ammonium acid urate occurred in obese or overweight children less than normal and underweight children (P<0.05). And cystine stones as well as carbonate apatite stones were more seen in abnormal BMI children (P<0.05).

CONCLUSIONS

The CR of endourological surgery in pediatric patients increased with decreasing BMI. Improving the nutritional status preoperatively could help reduce the postoperative complication. Infectious stones occurred more in underweight children.


15:42 - 15:45
S22-7 (PP)

★ WHAT IS THE OPTIMUM URETERIC STENT DWELLING TIME BEFORE RETROGRADE INTRARENAL SURGERY IN CHILDREN? A PROSPECTIVE RANDOMIZED STUDY

Ahmed FAHMY, Mohamed YOUSSIF, Walid DAWOOD, Haytham BADAWY and Omar ELGEBALY
Alexandria Faculty of Medicine, Urology Department, Alexandria, EGYPT

PURPOSE

It is difficult to determine the optimum ureteric stent dwelling time before retrograde intrarenal surgery (RIRS) at which the maximum benefit of ureteric dilation has been achieved with the minimal risk of infection and perioperative complications.

We studied the effect of dwelling time of ureteric stent in a group of children undergoing retrograde intrarenal surgery (RIRS) on perioperative outcomes and complication rates.

MATERIAL AND METHODS

A prospective randomization of 70 children aged less than 18 years, who were subdivided into two equal groups: Group 1 and 2 , each included 35 children who had undergone RIRS after ureteric stenting for one week and two weeks respectively. Both groups were compared to a historical control group (30 children) of unstented patients who underwent RIRS for kidney or proximal ureteric stones.

All Patients had a preoperative sterile urine culture and received single dose prophylactic i.v. antibiotics. Operative time, success of ureteroscope introduction, need for ureteric dilation, stone free rate and intra and post operative complications were recorded.

RESULTS

Operative time, intraoperative compliations, stone free rate were similar in both groups.
Group 1 and 2 had a higher stone free rate ( 95 % and 91%, respectively) compared to control group 82% with a significantly shorter operative time than control group.

Group 2 patients had a postoperative UTI two times as patient in group 1 ( 10 % vs 5 %). Moreover, Patients with a stent in situ for one week (group 1) had a similar risk of UTI to unstented patients (control group), however, 88 % and 90 of patients achieved successful ureteroscope introduction in group 1 and 2 respectively in comparison to 56 % in control group.

CONCLUSIONS

Prestenting facilitate future RIRS and achieve a higher stone free rate. Children should be scheduled for their definitive procedure within a week to achieve the benefits of prestenting whilst minimizing the potential for postoperative urinary tract infections.


15:45 - 15:57
Discussion