Are small residual stone fragments really insignificant in children?
Journal of Pediatric Surgery, cilt.48, sa.4, ss.840-844, 2013 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 48 Sayı: 4
- Basım Tarihi: 2013
- Doi Numarası: 10.1016/j.jpedsurg.2012.07.061
- Dergi Adı: Journal of Pediatric Surgery
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus
- Sayfa Sayıları: ss.840-844
- Anahtar Kelimeler: Children, Follow-up, Residual fragments, Renal stone
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
Objectives: To assess the significance of asymptomatic residual stone fragments of less than 4 mm (clinically insignificant residual fragments [CIRFs]) after shock wave lithotripsy (SWL), percutaneous nephrolithotomy (PNL), and retrograde intrarenal surgery (RIRS) in children. Patients and Methods: Eighty-five children were followed up for 6 to 50 months (median 22). Outcomes measured were fragment re-growth, stone events (emergency department visits, hospitalization, or additional interventions) and spontaneous fragment passage. Results: During follow-up, 22 children (25.8%) passed residual fragments spontaneously. Highest spontaneous passage rate was found for renal pelvis stones and the lowest for the lower pole stones (57.1% vs. 16.1%; p < 0.001). When the number of the fragments increased, the chance of the spontaneous passage decreased (30% vs 20%; p < 0.05). Symptomatic episodes including renal colic, hematuria, or urinary tract infection were documented in 34 (40%) patients, and re-growth of fragments was observed in 18 (21.2%). Stone size had no significant effect on spontaneous passage (p = 0.079), stone growth (p = 0.528), and symptomatic episodes (p = 0.402). Twenty-five patients (29.4%) required secondary intervention for stone re-growth or stone related events and the remaining 20 patients (23.5%) needed medical treatment for bothersome symptoms or complications. Conclusions: Our results suggest that 40% of children with CIRFs will become symptomatic and 20% will develop stone re-growth over the following 6 months. Only one fifth of the fragments will pass spontaneously without any complications. Therefore, the use of the term "CIRF" is not appropriate for postoperative residual fragments in children. © 2013 Elsevier Inc. All rights reserved.