Urological Institute of Northeastern New York, Albany Medical College, Albany, New York.
Urological Institute of Northeastern New York, Albany Medical College, Albany, New York.
J Urol. 2014 Feb;191(2):440-4. doi: 10.1016/j.juro.2013.09.021. Epub 2013 Sep 16.
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.
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.
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.
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.
在短期随访中，小儿尿石症已通过体外冲击波碎石术、输尿管镜检查和经皮肾镜取石术得到有效治疗，成功率较高。我们研究了至少随访 5 年的术后患者的成功率和可改变的危险因素。
对 1999 年至 2007 年间接受上尿路结石手术的年龄小于 18 岁的患者进行了回顾性图表审查，术后结石清除且随访时间至少 5 年。评估了复发率、解剖和代谢异常。
60 名符合条件的儿童中有 30 名（33 个肾脏）至少随访 5 年。手术时患者平均年龄为 10 岁，17 名女性，20 个肾脏存在解剖异常。5 年总复发率为 55%（95%CI 38%-70%）。输尿管结石的复发率低于肾结石（分别为 5/19 和 13/14，p<0.001）。异常解剖的患者 5 年内复发的可能性为 65%（95%CI 43%-82%），而正常解剖的患者为 38%（95%CI 18%-65%）（p=0.17）。18 次复发中有 10 次需要再次手术，7 次显示异常解剖，14 次涉及钙结石。对 13 名儿童进行 24 小时尿液检测，发现 10 名高钙尿症和 11 名低柠檬酸尿症，9 名患者同时存在这两种情况。
我们发现需要手术干预的儿童结石复发率较高，尤其是存在异常解剖的儿童。这一发现需要在更大的多中心复发率研究中得到证实。与此同时，我们的研究结果表明需要积极诊断和治疗代谢异常。
