Login to Access Video or Poster Abstract: MP66-17
Sources of Funding: None

Introduction

While successful surgery for pediatric nephrolithiasis minimizes the need for repeat interventions, staged procedures are sometimes necessary. We assessed predictors of repeat intervention for ureteroscopy (URS) and shock wave lithotripsy (SWL) in children utilizing a nationwide pediatric-specific administrative dataset, hypothesizing that repeat procedures would be higher for patients undergoing SWL.

Methods

Using the Pediatric Health Information System® dataset, we assessed all patients with nephrolithiasis from 2010 to August 2015 undergoing SWL or URS for an index stone surgery. Primary outcome was need for a repeat stone-related procedure, excluding cystoscopy with stent removal. Index treatment, stone location, presence of chronic comorbidity, use of ureteral stenting, presence of post-operative complications, age, gender, race, and insurance coverage were assessed as possible risk factors for repeat stone-related interventions. Statistical analyses with univariate and multi-variate modeling for mixed effects were performed.

Results

A total of 2788 patients undergoing URS (2216, 79.5%) and SWL (572, 20.5%) were identified. As compared to the SWL cohort, URS patients had higher rates of ureteral calculi (55.1 vs 17.1%, p < 0.001), were more frequently female (61.1% vs 53.5%, p = 0.0012) and older than 6 years of age (14.9% vs 5.2%, p < 0.001). Children undergoing URS had a higher rate of chronic comorbidity (27.1% vs 22.2%, p = 0.0163). Multivariate analysis with a mixed effects model is shown in the Table, assessing factors associated with repeat stone-related interventions.

Conclusions

Within the PHIS dataset, URS is performed more commonly than SWL for children with nephrolithiasis, especially for older children and those with ureteral calculi. SWL is associated with a 2.6-fold higher risk of repeat stone-related interventions. Intra-operative stent placement, younger age, chronic comorbidity and renal calculi are also associated with higher risks of repeat intervention on multivariate analysis. Prospective studies are needed to assess comparative effectiveness of SWL and URS in children and reduce risk for repeat surgical interventions in pediatric stone disease.

Funding

None