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Telli O et al, 2017: What happens to asymptomatic lower pole kidney stones smaller than 10 mm in children during watchful waiting?

Telli O, Hamidi N, Bagci U, Demirbas A, Hascicek AM, Soygur T, Burgu B.
Department of Pediatric Urology, School of Medicine, Ankara University, Sihhiye, Ankara, 06100, Turkey.
Department of Urology, School of Medicine, Ankara University, Ankara, Turkey.
Urology Clinic, Ankara Training and Research Hospital, Ankara, Turkey.

Abstract

BACKGROUND: The optimal management of lower pole kidney (LPK) stones in children is controversial. The aim of this study was to determine the outcomes of children with asymptomatic isolated LPK stones smaller than 10 mm during follow-up.
METHODS: A total of 242 patients with 284 stones presenting at our institution between June 2004 and December 2014 with an asymptomatic, single LPK stone with a diameter of RESULTS: The mean age and mean stone size were 9.4 ± 1.9 years and 7.4 ± 0.6 mm at admission, respectively. Stone progression rate was 61.2%, and the mean time for intervention was 19.2 ± 4.6 months. Flexible ureterorenoscopy (n = 68) or micro-percutaneous nephrolithotomy (n = 4) were performed for 72 stones (25.4%; group 1), and extracorporeal shock wave lithotripsy was performed for 102 stones (35.9%; group 2). The stone-free rates were 81.8 and 79.3% in group 1 and 2, respectively (p > 0.05). The remaining asymptomatic stones (110, 38.8%; group 3) were managed by continued observation, and at the end of the observation time (mean 40.8 ± 20.8 months) the spontaneous passage rate was 9.1% in this group. In the multivariate analysis, stone size of >7 mm, concurrent renal anomalies, and stones composed of magnesium ammonium phosphate (struvite) and cystine were statistically significant predictors of the need for intervention.
CONCLUSIONS: Children with stones larger than 7 mm, renal anomalies, or stones composed of metabolically active cystine or struvite are more likely to require intervention, and those with asymptomatic LPK stones smaller than 10 mm can be managed by continued observation.

Pediatr Nephrol. 2017 Jan 9. doi: 10.1007/s00467-016-3570-7. [Epub ahead of print]

 

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Comments 1

Peter Alken on Monday, 31 July 2017 07:49

Childhood urolithiasis is rare. The authors present a large number of 284 lower pole stones in 242 children seen within 10 years.
In all sections of the article the work up and the follow up of the cases is described in an almost textbook-like manner. Unfortunately the dropout rates are not given: “Although a large number of patients were enrolled in our study, the follow-up time was short because of the many patients who did not want to make regular visits to the clinic; this was especially true in the observation group.” Thus with a mean observation time of 40.8
± 20.8 months it is a little bit difficult to judge the conclusions.

Childhood urolithiasis is rare. The authors present a large number of 284 lower pole stones in 242 children seen within 10 years. In all sections of the article the work up and the follow up of the cases is described in an almost textbook-like manner. Unfortunately the dropout rates are not given: “Although a large number of patients were enrolled in our study, the follow-up time was short because of the many patients who did not want to make regular visits to the clinic; this was especially true in the observation group.” Thus with a mean observation time of 40.8 ± 20.8 months it is a little bit difficult to judge the conclusions.
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