MP40-09 SURGICAL OUTCOMES FOR PEDIATRIC UROLITHIASIS: INCREASED RETREATMENT RATES WITH SHOCKWAVE LITHOTRIPSY COMPARED TO URETEROSCOPY

Abstract

You have accessJournal of UrologyPediatrics: Testis & Varicoceles, Stones1 Apr 2015MP40-09 SURGICAL OUTCOMES FOR PEDIATRIC UROLITHIASIS: INCREASED RETREATMENT RATES WITH SHOCKWAVE LITHOTRIPSY COMPARED TO URETEROSCOPY Hsin-Hsiao Wang, Rohit Tejwani, John Wiener, and Jonathan Routh Hsin-Hsiao WangHsin-Hsiao Wang More articles by this author , Rohit TejwaniRohit Tejwani More articles by this author , John WienerJohn Wiener More articles by this author , and Jonathan RouthJonathan Routh More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1191AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Although shock wave lithotripsy (SWL) has long been the standard option for treatment of kidney stones in children, in recent years ureteroscopy (URS) has become increasingly common. However, there is little data comparing surgical outcomes between SWL and URS in pediatric stone disease on the population level. Our objective was to utilize state-wide datasets to compare surgical outcomes between SWL and URS. METHODS We searched the 2007-2010 CA, FL, NC, UT, and NY 2008-2010 State Ambulatory Surgery and Service Databases (SASD), State Emergency Department Databases (SEDD), and State Inpatient Databases (SID) to identify pediatric (<=18 years) renal or ureteral stone patients who received either SWL or URS as initial surgical intervention. Unplanned readmissions, additional procedures, and ER visits were extracted. Statistical analysis was performed using multivariate logistic regression and GEE to adjust for hospital-level clustering. RESULTS We identified 1,001 SWL and 1,095 URS patients. Compared with patients undergoing SWL, URS patients were more likely to be older (15.4 v. 14.7 years, p<0.001), female (64 v. 55%, p<0.001), & privately insured (66 v. 56%, p<0.001); URS was also more likely to be used for ureteral v. renal stones (82 v. 35%, p<0.001). URS had a significantly lower rate of repeat urolithiasis procedures (98 (9.8%) v. 54 (4.9%), p<0.001) but had similar rates of readmission (69 (6.3) v. 54 (5.4%), p=0.15) and unplanned ER visits (159 (14.5%) v. 126 (12.6%), p=0.07). After adjusting for age, gender, insurance status, Charlson comorbidity score, treatment year, stone location, income, and hospital clustering, patients treated with SWL remained significantly more likely to undergo repeat urolithiasis procedures (OR=1.71, p=0.008). CONCLUSIONS In our population, URS was a more common intervention for pediatric urolithiasis than SWL. Postoperative readmissions and ER visits were uncommon after surgical intervention for pediatric urolithiasis. Even after correcting for multiple other clinical factors, however, surgical retreatment rates were twice as high for SWL as compared to URS. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e466 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hsin-Hsiao Wang More articles by this author Rohit Tejwani More articles by this author John Wiener More articles by this author Jonathan Routh More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...