URETEROPELVIC JUNCTION OBSTRUCTION WITH CONCURRENT RENAL PELVIC CALCULI IN THE PEDIATRIC-PATIENT - A LONG-TERM FOLLOW-UP

Purpose: We determined the long-term prognosis of the pediatric patien t presenting with simultaneous ureteropelvic junction obstruction and a renal calculus. Materials and Methods: We retrospectively reviewed a ll individuals younger than 17 years who presented to our institutions with simultaneous ureteropelvic junction obstruction and an ipsilater al renal calculus. Results: Simultaneous ureteropelvic junction obstru ction with nonstruvite calculi was present in 22 patients, while 6 had struvite calculi. Median age at diagnosis was 11 years (range 5 to 16 ). During a median followup of 9 years (range 2 to 38) renal calculi r ecurred in 19 patients (68%), including 10 (36%) with 1 and 9 (32%) wi th 2 or more recurrences. Median time to first stone recurrence was 11 years (range 2 to 38). Of the 22 patients with nonstruvite calculi 15 (68%) had recurrence. An identifiable metabolic etiology for renal li thiasis was found in 13 of these patients (87%). In contrast, only 2 o f the 7 patients (29%) with nonstruvite calculi and no recurrent stone s had an identifiable abnormality. This finding suggests that the pres ence of an identifiable metabolic abnormality significantly predispose s to recurrent nonstruvite renal lithiasis (p <0.01). Conclusions: Of the pediatric patients presenting with simultaneous ureteropelvic junc tion obstruction and a renal calculus 68% will have recurrent renal li thiasis. It remains to be determined whether active treatment of coexi sting metabolic abnormalities could prevent or reduce the incidence of recurrent stone disease.