Patient and stone characteristics associated with surgical intervention in pediatrics

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.