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Fernandez N, Ellison JS, Wang Z, Huang J, Chu DI, Sturm R, Stec AA, Hsi RS, Wu W, Nelson C, Ching C, Augelli B, Lorenzo M, Bi-Karchin J, Tasian GE. Surgeon, and Institution Characteristics Associated Surgical Preferences in the Pediatric KIDney Stone Care Improvement Network. Urology 2024; 187:64-70. [PMID: 38458327 DOI: 10.1016/j.urology.2024.02.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 01/26/2024] [Accepted: 02/27/2024] [Indexed: 03/10/2024]
Abstract
OBJECTIVE To reveal barriers and opportunities to implement evidence for the management of pediatric kidney stone disease, we determined surgeon and institutional factors associated with preferences for the type of surgical intervention for kidney and ureteral stones. METHODS We conducted a cross-sectional study of urologists participating in the Pediatric KIDney Stone Care Improvement Network (PKIDS) trial. Questionnaires ascertained strengths of urologists' preferences for types of surgery as well as characteristics of participating urologists and institutions. The outcome was the strength of preferences for ureteroscopy, shockwave lithotripsy, and percutaneous nephrolithotomy for four scenarios for which two alternative procedures are recommended by the AUA guidelines: (1) 2 cm kidney stone, (2) 9 mm proximal ureteral stone, (3) 1.5 cm lower pole kidney stone, (4) 1 cm nonlower pole kidney stone. Principal component analysis was performed to identify unique clusters of factors that explain surgical preferences. RESULTS One hundred forty-eight urologists at 29 sites completed surveys. Stated preferences were highly skewed except for the choice between ureteroscopy and percutaneous nephrolithotomy for a 1.5 cm kidney stone. Shockwave lithotripsy ownership and local practice patterns most frequently associated with the strength of surgeons' preferences for the type of surgery. Principal component analysis revealed that three clusters of stone, patient, and heterogenous characteristics explained 30% of the variance in preferences. CONCLUSION There is wide variation in the strengths of preferences for surgical interventions supported by current guidelines that are partially explained by surgeon and institutional characteristics. These results reveal opportunities to develop strategies for guidelines that consider real-world drivers of care.
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Affiliation(s)
- Nicolas Fernandez
- Department of Surgery, Division of Urology, Seattle Children's Hospital, Seattle, WA
| | | | - Zi Wang
- Department of Biostatistics, Epidemiology, and Informatics; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Jing Huang
- Department of Biostatistics, Epidemiology, and Informatics; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - David I Chu
- Ann & Robert H. Lurie Children's Hospital of Chicago, Division of Urology. Chicago, IL
| | - Renea Sturm
- Mattel Children's Hospital, Department of Urology, University of California, Los Angeles, CA
| | - Andrew A Stec
- Division of Urology, Nemours Children's Health, Jacksonville, FL
| | - Ryan S Hsi
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN
| | - Wayland Wu
- Division Pediatric Urology, Cohen Children's Medical Center of New York, Zucker School of Medicine at Hofstra/Northwell, Long Island, NY
| | - Caleb Nelson
- Department of Urology, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Christina Ching
- Kidney and Urinary Tract Center, Department of Pediatric Urology, Nationwide Children's Hospital, Columbus, OH
| | - Brian Augelli
- Department of Surgery, Division of Urology, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Matt Lorenzo
- Department of Surgery, Division of Urology, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Jing Bi-Karchin
- Department of Surgery, Division of Urology, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Gregory E Tasian
- Department of Biostatistics, Epidemiology, and Informatics; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Department of Surgery, Division of Urology, The Children's Hospital of Philadelphia, Philadelphia, PA.
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Campbell P, Mudd B, Craig K, Daugherty M, Vanderbrink B, DeFoor W, Minevich E, Reddy P, Strine A. One and done: Feasibility and Safety of Primary Ureteroscopy in a Pediatric Population. J Pediatr Urol 2024; 20:224.e1-224.e7. [PMID: 37957074 DOI: 10.1016/j.jpurol.2023.10.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/24/2023] [Accepted: 10/27/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Pediatric urolithiasis has been increasing at rate of 4-10 % annually in the United States, most notably within adolescents and females. A significant number of patients will require surgical management of their stones. Primary ureteroscopy (URS) affords the opportunity to treat stones under a single anesthetic with lower re-treatment rates or anatomical and stone characteristic limitations compared to shockwave lithotripsy. Previous studies evaluating primary URS have been largely underpowered, are limited by stone location, and/or are not representative of the stone population in the United States. OBJECTIVES Primary study outcomes were the success of primary URS and patient characteristics associated with success. Secondary outcomes were the stone-free rate (SFR), 30-day emergency department (ED) visits, 30-day readmissions, and complications. METHODS We performed a retrospective cohort study of patients less than 18 years of age from 2011 to 2023 who underwent primary URS. Patients were excluded if a ureteral stent was placed prior to URS or diagnostic URS was performed. A successful primary URS was considered if access to the ureter was obtained and treatment of the stone(s) completed. In failed primary URS, a ureteral stent was placed for staged management. RESULTS A total of 196 patients were included and primary URS was performed or attempted on 224 renal units. The median age was 15.8 (IQR 13.4-16.9) years and median follow up 8.4 (IQR 1.1-24.6) months. The success rate of primary URS was 79 %. No significant characteristics were appreciated for successful primary URS based on: overall age, <14 vs > 14 years of age, sex, body mass index, history of stones, history of endourologic procedures, preoperative alpha blockade, location of stone(s), multiple stones, type of URS, or acute treatment. In successful primary URS, the SFR was 88 % with stone size (p = 0.0001) the only predictor of having residual stones. The 30-day ED rate was 21.4 %, 30-day unplanned readmission rate was 12.5 %, and complication rate was 7.5 %. No long-term complications were appreciated. DISCUSSION Our success of primary URS compares favorably to previously published literature. Our SFR rate, 30-day ED visits, 30-day unplanned readmission, and complication rates are similar to other studies. Limitations of the study are its retrospective design, selection bias, and intermediate follow-up. CONCLUSIONS Primary URS can be completed safely in the majority of pediatric patients without any patient characteristics associated with success. We advocate for primary URS when possible due to the excellent SFR and potential of treating stones under a single anesthetic.
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Affiliation(s)
- Paul Campbell
- Cincinnati Children's Hospital Medical Center, Department of Urology, Cincinnati, OH, 3333 Burnet Avenue, Cincinnati, OH 45229, USA.
| | - Brandon Mudd
- University of Cincinnati, Department of Urology, Cincinnati, OH, 231 Albert Sabin Way, Cincinnati, OH 45267, USA.
| | - Kiersten Craig
- Cincinnati Children's Hospital Medical Center, Department of Urology, Cincinnati, OH, 3333 Burnet Avenue, Cincinnati, OH 45229, USA.
| | - Michael Daugherty
- Cincinnati Children's Hospital Medical Center, Department of Urology, Cincinnati, OH, 3333 Burnet Avenue, Cincinnati, OH 45229, USA.
| | - Brian Vanderbrink
- Cincinnati Children's Hospital Medical Center, Department of Urology, Cincinnati, OH, 3333 Burnet Avenue, Cincinnati, OH 45229, USA.
| | - William DeFoor
- Cincinnati Children's Hospital Medical Center, Department of Urology, Cincinnati, OH, 3333 Burnet Avenue, Cincinnati, OH 45229, USA.
| | - Eugene Minevich
- Cincinnati Children's Hospital Medical Center, Department of Urology, Cincinnati, OH, 3333 Burnet Avenue, Cincinnati, OH 45229, USA.
| | - Pramod Reddy
- Cincinnati Children's Hospital Medical Center, Department of Urology, Cincinnati, OH, 3333 Burnet Avenue, Cincinnati, OH 45229, USA.
| | - Andrew Strine
- Cincinnati Children's Hospital Medical Center, Department of Urology, Cincinnati, OH, 3333 Burnet Avenue, Cincinnati, OH 45229, USA.
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Williams VW, Finkelstein JB. Speaking and listening: The importance of stakeholder engagement in quality improvement in pediatric urology. J Pediatr Urol 2023; 19:792-799. [PMID: 37689553 DOI: 10.1016/j.jpurol.2023.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 08/04/2023] [Accepted: 08/17/2023] [Indexed: 09/11/2023]
Abstract
To improve health care, we as clinicians must work to change processes that make it easier to do our job well and reliably every day. Before improving a process, we must understand it and this often requires employing the expertise of others. Indeed, quality improvement work is often done in teams. The key is identifying and engaging the right stakeholders for each improvement initiative. The goal of this review is to provide health care professionals with the basis for how to do this. We describe four essential stakeholder steps that aid in the success of a quality improvement initiative. The steps of 1.) identifying and 2.) categorizing stakeholders involve spending the time to think about who the necessary stakeholders are and how to organize them. It is essential to consider stakeholders who are balanced for expertise, skills, experience, perspective, gender, race, and ethnicity. The process then moves on to 3.) analyzing stakeholders, which supports efforts that are focused on the stakeholder relationships that will most impact project success. The final step is 4.) stakeholder engagement. This represents a critical opportunity, not only upfront, but also to maintain a high level of stakeholder engagement throughout the quality improvement project. As the improvement work evolves, it is important to return to the earlier steps and reflect on the stakeholder group; the process is iterative. Devoting sufficient energy and time to these stakeholder steps will provide ample returns. This review should assist health care professionals in establishing an improvement team for each quality improvement initiative, which is foundational to initiating change efforts that better system performance, enhance the quality of care, and ensure patient safety.
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Chua ME, Silangcruz JM, Kim JK, Koyle MA, Sriharan A. A Scoping Review on Learning Health Networks Available in Pediatric Surgical Specialties. J Pediatr Surg 2023; 58:2416-2428. [PMID: 37544802 DOI: 10.1016/j.jpedsurg.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 07/10/2023] [Accepted: 07/10/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND Learning health networks (LHN) are consortia of institutions that collaborate and embrace the elements of the learning health system (LHS), including quality improvement, education, research, and stakeholder involvement. Their ultimate goal is rapid information dissemination in clinical care. Pediatric surgical specialties perform unique yet high-impact procedures that could benefit from LHN, thereby improving surgical outcomes and care through LHS approaches. Consequently, health system leaders should be aware of LHN and their importance in enhancing surgical care and improving outcomes. This scoping review aims to map and characterize the existing LHN applied in pediatric surgical specialties. METHODS A systematic literature search was performed on Medline, EMBASE, and Scopus up to June 2022, with an update search conducted in May 2023. Additionally, Google Scholar, ProQuest and inquiry from topic experts were used for cross-referencing relevant review articles to identify grey literature. This scoping review was conducted and reported according to the PRISMA-scoping review extension. RESULTS A total of 56 publications for 19 LHN were identified and included in this scoping review. Out of 19 identified LHN in pediatric surgical specialties, 18 were organized in North America. Eight of the networks are related to pediatric general surgery and another eight were related to pediatric transplantation. The 16 out of 19 LHN were initiated after 2001. To date, only eight of the LHNs generated reports of comparative improved outcomes. CONCLUSION This scoping review provides an overview of the available LHNs in pediatric surgical specialties. Over the past decade, several pediatric surgical specialties have embraced the principles of learning health systems, forming inter-institutional collaborations that utilize information technology to generate big data on patient-level clinical information, engage in quality improvement cycles, adopt evidence-based practices, and actively involve patients and stakeholders. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Michael E Chua
- Global Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada; Division of Urology, Department of Surgery, The Hospital for Sick Children, Toronto, ON, Canada; Institute of Urology, St. Luke's Medical Center, Quezon City, NCR, Philippines.
| | | | - Jin Kyu Kim
- Department of Surgery, Faculty of Medicine and Surgery, University of Toronto, ON, Canada
| | - Martin A Koyle
- System Leadership and Innovation, Institute of Health Policy, Management and Evaluation, University of Toronto, ON, Canada
| | - Abi Sriharan
- System Leadership and Innovation, Institute of Health Policy, Management and Evaluation, University of Toronto, ON, Canada
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Juliebø-Jones P, Ulvik Ø, Beisland C, Somani BK. Paediatric percutaneous nephrolithotomy (P-PCNL) reporting checklist. Scand J Urol 2023; 58:115-119. [PMID: 37987596 DOI: 10.2340/sju.v58.13392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 09/06/2023] [Indexed: 11/22/2023]
Abstract
OBJECTIVE To develop a reporting checklist that serves to improve and standardise reporting in studies pertaining to paediatric percutaneous nephrolithotomy (PCNL). METHODS Based on findings from systematic review of literature, a draft list of items was formulated. By process of review and revisions, a finalised version was established and consensus achieved. RESULTS The finalised version of the checklist covers four main sections, which include the following areas: study details, pre-operative, operative and post-operative information. There are 18 further sub-items. Recommendations deemed to be of high importance to include are highlighted in bold. CONCLUSION This practical tool can aid clinicians and researchers when undertaking and reviewing studies on paediatric PCNL. This is highly relevant given the current heterogeneity that exists as well as debate in best practice patterns.
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Affiliation(s)
- Patrick Juliebø-Jones
- Department of Urology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway; EAU YAU Urolithiasis Group, Arnhem, The Netherlands.
| | - Øyvind Ulvik
- Department of Urology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Christian Beisland
- Department of Urology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
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Denburg MR, Razzaghi H, Goodwin Davies AJ, Dharnidharka V, Dixon BP, Flynn JT, Glenn D, Gluck CA, Harshman L, Jovanovska A, Katsoufis CP, Kratchman AL, Levondosky M, Levondosky R, McDonald J, Mitsnefes M, Modi ZJ, Musante J, Neu AM, Pan CG, Patel HP, Patterson LT, Schuchard J, Verghese PS, Wilson AC, Wong C, Forrest CB. The Preserving Kidney Function in Children With CKD (PRESERVE) Study: Rationale, Design, and Methods. Kidney Med 2023; 5:100722. [PMID: 37965485 PMCID: PMC10641283 DOI: 10.1016/j.xkme.2023.100722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023] Open
Abstract
Rationale & Objective PRESERVE seeks to provide new knowledge to inform shared decision-making regarding blood pressure (BP) management for pediatric chronic kidney disease (CKD). PRESERVE will compare the effectiveness of alternative strategies for monitoring and treating hypertension on preserving kidney function; expand the National Patient-Centered Clinical Research Network (PCORnet) common data model by adding pediatric- and kidney-specific variables and linking electronic health record data to other kidney disease databases; and assess the lived experiences of patients related to BP management. Study Design Multicenter retrospective cohort study (clinical outcomes) and cross-sectional study (patient-reported outcomes [PROs]). Setting & Participants PRESERVE will include approximately 20,000 children between January 2009-December 2022 with mild-moderate CKD from 15 health care institutions that participate in 6 PCORnet Clinical Research Networks (PEDSnet, STAR, GPC, PaTH, CAPRiCORN, and OneFlorida+). The inclusion criteria were ≥1 nephrologist visit and ≥2 estimated glomerular filtration rate (eGFR) values in the range of 30 to <90 mL/min/1.73 m2 separated by ≥90 days without an intervening value ≥90 mL/min/1.73 m2 and no prior dialysis or kidney transplant. Exposures BP measurements (clinic-based and 24-hour ambulatory BP); urine protein; and antihypertensive treatment by therapeutic class. Outcomes The primary outcome is a composite event of a 50% reduction in eGFR, eGFR of <15 mL/min/1.73 m2, long-term dialysis or kidney transplant. Secondary outcomes include change in eGFR, adverse events, and PROs. Analytical Approach Longitudinal models for dichotomous (proportional hazards or accelerated failure time) and continuous (generalized linear mixed models) clinical outcomes; multivariable linear regression for PROs. We will evaluate heterogeneity of treatment effect by CKD etiology and degree of proteinuria and will examine variation in hypertension management and outcomes based on socio-demographics. Limitations Causal inference limited by observational analyses. Conclusions PRESERVE will leverage the PCORnet infrastructure to conduct large-scale observational studies that address BP management knowledge gaps for pediatric CKD, focusing on outcomes that are meaningful to patients. Plain-Language Summary Hypertension is a major modifiable contributor to loss of kidney function in chronic kidney disease (CKD). The purpose of PRESERVE is to provide evidence to inform shared decision-making regarding blood pressure management for children with CKD. PRESERVE is a consortium of 16 health care institutions in PCORnet, the National Patient-Centered Clinical Research Network, and includes electronic health record data for >19,000 children with CKD. PRESERVE will (1) expand the PCORnet infrastructure for research in pediatric CKD by adding kidney-specific variables and linking electronic health record data to other kidney disease databases; (2) compare the effectiveness of alternative strategies for monitoring and treating hypertension on preserving kidney function; and (3) assess the lived experiences of patients and caregivers related to blood pressure management.
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Affiliation(s)
- Michelle R. Denburg
- Children’s Hospital of Philadelphia, Philadelphia, PA
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | | | | | - Vikas Dharnidharka
- St. Louis Children’s Hospital, Washington University in St. Louis School of Medicine, St. Louis, MO
| | - Bradley P. Dixon
- Children’s Hospital Colorado, University of Colorado School of Medicine, Aurora, CO
| | - Joseph T. Flynn
- Seattle Children’s Hospital, University of Washington School of Medicine, Seattle, WA
| | - Dorey Glenn
- University of North Carolina School of Medicine, Chapel Hill, NC
| | | | - Lyndsay Harshman
- University of Iowa Stead Family Children’s Hospital, Iowa City, IA
| | | | | | | | | | | | - Jill McDonald
- Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Mark Mitsnefes
- Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, OH
| | - Zubin J. Modi
- C.S. Mott Children’s Hospital, University of Michigan, Ann Arbor, MI
| | | | - Alicia M. Neu
- Johns Hopkins Children’s Center, Johns Hopkins School of Medicine, Baltimore, MD
| | - Cynthia G. Pan
- Medical College of Wisconsin, Children’s Wisconsin, Milwaukee, WI
| | - Hiren P. Patel
- Nationwide Children’s Hospital, The Ohio State University College of Medicine, Columbus, OH
| | | | | | - Priya S. Verghese
- Lurie Children’s Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Amy C. Wilson
- Riley Children’s Health, Indiana University School of Medicine, Indianapolis, IN
| | - Cynthia Wong
- Stanford Children’s Health, Stanford University School of Medicine, Palo Alto, CA
| | - Christopher B. Forrest
- Children’s Hospital of Philadelphia, Philadelphia, PA
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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Fernandez N, Silverii H, Dangle P, Yonekawa K. Atypical clinical presentation and management of urinary stone disease in non-verbal non-ambulatory children. J Pediatr Urol 2023; 19:560.e1-560.e6. [PMID: 37344296 DOI: 10.1016/j.jpurol.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 05/26/2023] [Accepted: 06/01/2023] [Indexed: 06/23/2023]
Abstract
INTRODUCTION Management of kidney stones primarily depends on various factors such as the presence of urinary tract obstruction, pain, stone size, location, impact on renal function, and the existence of infection. Renal colic is the classic presentation of an obstructive kidney stone. However, in this study, we present a cohort of non-verbal non-ambulatory (NVNA) patients who exhibit a distinct and uncommon presentation of kidney stones due to their medical conditions. Information about kidney stone disease in this gropup of complex pediatric patients is, scarce and their associated risk factors are not well understood. Therefore, we aim to summarize the clinical presentation, and management challenges in this unique group of NVNA patients to identify potential variables for prospective studies. METHODS A retrospective chart review was completed for all NVNA patients seen at the pediatric multidisciplinary kidney stone clinic between July 2020 to August 2022. Demographic variables, clinical presentation data, metabolic evaluation, radiological imaging, and surgical management was included for analysis. RESULTS A total of 224 pediatric patients were referred to the multidisciplinary stone clinic. Of those, 27 were identified to be NVNA. The most common primary diagnosis was Cerebral Palsy followed by Lennox-Gastaut syndrome. Average age at first kidney stone presentation was 11.5 years ± 5.7 years. An obstructing stone was diagnosed in 18 (66%) patients, 4 (22.2%) of these presented with sepsis. Average stone burden was 9.2 mm ( ± 5.8 mm). Of the obstructing stones, 13 (72%) were in the kidney. All patients with an obstructing stone underwent surgical management with retrograde endoscopic approach. Metabolic 24-h-urine analysis was completed in 24 (89%) patients. 17 (62%) had an elevated urine density, 15 (55%) demonstrated calcium oxalate supersaturation, 12 (44%) met criteria for acidosis, and 7 (26%) had significant hypocitraturia. DISCUSSION NVNA patients represent a unique cohort whose clinical presentation is atypical. Limited ability to express symptoms makes early detection difficult to recognize. Twenty two percent of patients present with sepsis as their first manifestation of an acutely obstructing kidney stone. Pain is subjectively interpreted by caregivers and is an uncommon symptom. Our cohort demonstrates common risk factors for stones including propensity for chronic dehydration, slow urinary tract transit, ineffective bladder emptying, G-tube feeding, and lithogenic medications. CONCLUSION NVNA pediatric patients have atypical kidney stone clinical presentation. Awareness of this unique group of patients should support future collaborative studies to focus on understanding these atypical presentations and reflect on improving management.
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Affiliation(s)
- Nicolas Fernandez
- Division of Pediatric Urology, Seattle Children's Hospital, University of Washington, Seattle, USA.
| | - Hailey Silverii
- Division of Pediatric Urology, Seattle Children's Hospital, University of Washington, Seattle, USA
| | - Pankaj Dangle
- Division of Pediatric Urology, Riley Children's Hospital, Indiana University, Indianapolis USA
| | - Karyn Yonekawa
- Division of Pediatric Nephrology, Seattle Children's Hospital, University of Washington, Seattle, USA
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Carmen Tong CM, Ellison JS, Tasian GE. Pediatric Stone Disease: Current Trends and Future Directions. Urol Clin North Am 2023; 50:465-475. [PMID: 37385708 DOI: 10.1016/j.ucl.2023.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
Pediatric nephrolithiasis is less common in children than in adults but the incidence has been rising rapidly, and it is now a public health and economic burden in the United States. There are challenges unique to children that should be taken into consideration when evaluating and managing pediatric stone disease. In this review, we present the current research on risk factors, emerging new technologies for treatment of stones and recent investigations on prevention of stones in this population.
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Affiliation(s)
- Ching Man Carmen Tong
- Department of Pediatric Urology, University of Alabama at Birmingham, 1600 7th Avenue South, Lowder Suite 318, Birmingham, AL 35233, USA.
| | - Jonathan S Ellison
- Department of Urology, Medical College of Wisconsin, Children's Hospital of Wisconsin and Medical College of Wisconsin, 9000 West Wisconsin Avenue, Milwaukee, WI 53226, USA
| | - Gregory E Tasian
- Division of Urology, Department of Surgery, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA
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Ghidini F, Di Pietro C, Fidanza F, Durante V, Ceccarelli PL. The role of mini-PCNL as primary approach for the treatment of pediatric kidney stones in a high-income country. Ten-year single-center report. Pediatr Surg Int 2023; 39:220. [PMID: 37358645 DOI: 10.1007/s00383-023-05504-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/18/2023] [Indexed: 06/27/2023]
Abstract
PURPOSE To describe our experience in the use of percutaneous nephrolithotomy (PCNL) as a primary treatment for paediatric kidney stones and to highlight its benefits. METHODS The design was retrospective and observational. All the children treated for kidney stones from 2011 to 2021 were included. The population was divided into Group A (PCNL) and Group B (retrograde intrarenal surgery, RIRS). The outcomes were stone-free rate (SFR), the rate of procedures per patient, the rate of failure and the rate of complications. RESULTS Twenty-eight patients with 33 kidney units were included. Eighteen of them (64%) were males. The median age was 10 (IQR 6.8-13) years. Forty-seven procedures were performed. Twenty-four of them (51%) were mini-PCNL. Group A included 17 patients (61%). Group A presented a higher SFR (p = 0.007) and a lower number of procedures (p < 0.001). RIRS failed in five cases (45%) because of non-compliant ureter. Two urinary tract infections (UTI) were reported after PCNL and four UTIs after RIRS (p = 0.121). No major complications were reported. CONCLUSION Mini-PCNL should be suggested as a primary approach for pediatric kidney stones. This technique presented a better effectiveness with a reduced number of procedures when compared to RIRS.
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Affiliation(s)
- Filippo Ghidini
- Pediatric Surgery Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Via del Pozzo 71, Modena, Italy.
| | - Corradino Di Pietro
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Francesco Fidanza
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Viviana Durante
- Pediatric Surgery Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Via del Pozzo 71, Modena, Italy
| | - Pier Luca Ceccarelli
- Pediatric Surgery Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Via del Pozzo 71, Modena, Italy
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10
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Juliebø-Jones P, Keller EX, Tzelves L, Beisland C, Somani BK, Gjengstø P, Æsøy MS, Ulvik Ø. Paediatric kidney stone surgery: state-of-the-art review. Ther Adv Urol 2023; 15:17562872231159541. [PMID: 36950219 PMCID: PMC10026105 DOI: 10.1177/17562872231159541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 02/07/2023] [Indexed: 03/24/2023] Open
Abstract
While urolithiasis in children is rare, the global incidence is rising, and the volume of minimally invasive surgeries being performed reflects this. There have been many developments in the technology, which have supported the advancement of these interventions. However, innovation of this kind has also resulted in wide-ranging practice patterns and debate regarding how they should be best implemented. This is in addition to the extra challenges faced when treating stone disease in children where the patient population often has a higher number of comorbidities and for example, the need to avoid risk such as ionising exposure is higher. The overall result is a number of challenges and controversies surrounding many facets of paediatric stone surgery such as imaging choice, follow-up and different treatment options, for example, medical expulsive therapy, shockwave lithotripsy, ureteroscopy, and percutaneous nephrolithotomy. This article provides an overview of the current status of paediatric stone surgery and discussion on the key topics of debate.
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Affiliation(s)
| | - Etienne Xavier Keller
- Department of Urology, University Hospital
Zurich, University of Zurich, Zurich, Switzerland EAU YAU Urolithiasis
Group, Arnhem, The Netherlands
| | - Lazaros Tzelves
- Second Department of Urology, National and
Kapodistrian University of Athens, Sismanogleio General Hospital, Athens,
Greece EAU YAU Urolithiasis Group, Arnhem, The Netherlands
| | - Christian Beisland
- Department of Urology, Haukeland University
Hospital, Bergen, NorwayDepartment of Clinical Medicine, University of
Bergen, Bergen, Norway
| | - Bhaskar K Somani
- Department of Urology, University Hospital
Southampton, Southampton, UK
| | - Peder Gjengstø
- Department of Urology, Haukeland University
Hospital, Bergen, Norway
| | | | - Øyvind Ulvik
- Haukeland University Hospital, Bergen,
NorwayDepartment of Clinical Medicine, University of Bergen, Bergen,
Norway
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