德国西南部儿童和青少年症状性尿路结石治疗中的指南依从性。
Guideline-adherence in the treatment of symptomatic urolithiasis in children and adolescents in southwestern Germany.
机构信息
Department of Urology, Katharinenhospital, Kriegsbergstr. 60, 70174, Stuttgart, Germany.
Department of Pediatrics and Adolescent Medicine, Medical University Ulm, Eytthstr. 24, 89075, Ulm, Germany.
出版信息
BMC Urol. 2020 Jun 26;20(1):76. doi: 10.1186/s12894-020-00643-0.
BACKGROUND
Approximately 1% of urolithiasis cases in Germany affect children. Interdisciplinary groups have agreed on national and international guidelines for children to recommend appropriate treatment pathways. The aim of this retrospective and preliminary study is to analyze whether adherence to current guidelines for pediatric stone disease in southwestern Germany is feasible.
METHODS
During 2014 to 2017 24 children and adolescents (nine female, 15 male, median age 9.7 years), were treated for symptomatic urolithiasis in our institutions. We retrospectively collected clinical and operative courses. Clinical pathways were compared to previous guideline recommendations of the EAU 2014 and the German S2k guideline 2015.
RESULTS
17 of the 24 patients were treated according to guideline recommendations (71%). Non-adherency was based on parental decisions in two and technical/medical considerations in five cases. In 11 children (45.8%) secondary or adjunctive treatments were necessary, in three of the seven non-adherently treated (43%) and in eight of the 17 adherently treated children (47%).
CONCLUSION
Our daily treatment approach seems to comply well with current pediatric stone guidelines. Nevertheless, guideline-non-adherent decision making emphasizes their strength and limitations, as specific clinical situations in children may require an individual treatment plan, as non-predictable conditions may occur.
背景
在德国，约有 1%的尿石症病例发生在儿童中。跨学科小组已经就儿童的国家和国际指南达成一致，以推荐适当的治疗途径。本回顾性初步研究的目的是分析德国西南部儿童结石病是否符合现行指南。
方法
2014 年至 2017 年间，我们机构共治疗了 24 例儿童和青少年（9 名女性，15 名男性，中位年龄 9.7 岁）的症状性尿石症。我们回顾性地收集了临床和手术过程。临床路径与 EAU 2014 年和德国 S2k 指南 2015 年的先前指南建议进行了比较。
结果
24 例患者中有 17 例（71%）按照指南建议进行治疗。不遵守的原因是基于父母的决定在 2 例，基于技术/医学考虑在 5 例。在 11 例儿童（45.8%）中需要进行二级或辅助治疗，在 7 例不遵守治疗的儿童中有 3 例（43%），在 17 例遵守治疗的儿童中有 8 例（47%）。
结论
我们的日常治疗方法似乎与当前的儿科结石指南相符。然而，不符合指南的决策强调了它们的优势和局限性，因为儿童的具体临床情况可能需要个体化的治疗计划，因为可能会出现不可预测的情况。
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