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Why Aren’t Pediatric Kidney Stone Patients Returning for Follow-up After Surgery?

Why Aren’t Pediatric Kidney Stone Patients Returning for Follow-up After Surgery? 1024 732 Lauren Dembeck

Kidney stones in children are on the rise, and many of these children miss critical post-op follow-ups. What prevents them from returning, and how can we help?

Since 2000, kidney stone cases in the U.S. pediatric population have risen by 6–10% annually, leading to a corresponding increase in surgical interventions. Alarmingly, nearly half of pediatric patients experience symptomatic recurrence within three years. Thus, post-operative follow-up is critical not only to evaluate for complications but also to discuss strategies to prevent stone recurrence. While data on long-term compliance with therapy has been assessed in adults, such studies have been limited in children.

Recently, Nationwide Children’s Hospital was a study site for the Pediatric KIDney Stone (PKIDS) Care Improvement Network research study, a groundbreaking project comparing the effectiveness of different surgical methods for removing kidney stones in children and young adults.

Christina Ching, MD

“The study had a strict protocol to assess surgical outcomes, and participating children needed to return to the clinic for their post-operative visit and imaging,” says Christina Ching, MD, a pediatric urologist at Nationwide Children’s. “Our research coordinator noticed that some patients were not returning as asked for post-operative visits and imaging as requested, and so, we started asking why.”

Dr. Ching and colleagues saw this as an opportunity to collect valuable data on follow-up rates and to evaluate if socioeconomic and demographic factors predict follow-up after surgical intervention in the pediatric stone population. Their findings were recently published in the Journal of Pediatric Urology.

“Compliance in children is arguably more complex than in adults because they are typically reliant on caregivers or other adults for transportation to appointments,” adds Dr. Ching.

Their retrospective study included all patients with a scheduled post-operative follow-up office visit following a first-time stone surgery at Nationwide Children’s over a 5 year period (2016-2020). The research team reviewed electronic charts for patient demographics, stone characteristics, surgical method (ureteroscopy, shock wave lithotripsy, and percutaneous nephrolithotomy ), and characteristics of intervention. The primary outcome of the study was attendance of a scheduled provider visit within 6 months after surgery.

The study included 195 pediatric patients with a median age of 15.4 years at surgery. The majority were non-Hispanic white (86%) and female (62%). Most underwent only ureteroscopy (86%). Overall, 146 of the 195 patients (75%) attended a post-operative office visit within 6 months after surgery.

Patients who did not attend the scheduled follow-up visit were more likely to have indicators of lower socioeconomic status than patients who attended, specifically having public insurance (e.g., Medicaid/sCHIP; 80% vs 44%; pP<0.01) and being in a single-parent household (40% vs 23%; p=0.02).

Patients who attended a preoperative urology clinic visit were more likely than those who did not attend such a visit to attend their post-operative follow-up visit (60% vs 41%; p=0.02).

“These findings allow us to identify and provide support for patients who are at risk of not following up,” says Dr. Ching. “Lower socioeconomic status is known to be a hindrance to accessing health care. Some stressors families may be facing, such as lack of transportation, are actionable matters with which our clinics, such as our multidisciplinary specialty stone clinic, may be able to provide families assistance. ”

Dr. Ching also highlights the importance of establishing a relationship with the patient and family before surgery as this had a positive effect on patient follow-up. “Having a more developed relationship will help people feel comfortable coming back, and the early counseling may help them understand why follow-up is important.”

 

Reference

Stout M, Lombardo A, Thompson N, Benedict J, Alpert S, DaJusta D, Fuchs M, Jayanthi R, Mcleod D, Ching CB. Predictors of follow-up of pediatric stone patients after surgical intervention. J Pediatr Urol. 2025 Feb;21(1):23-28.

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About the author

Lauren Dembeck, PhD, is a freelance science and medical writer based in New York City. She completed her BS in biology and BA in foreign languages at West Virginia University. Dr. Dembeck studied the genetic basis of natural variation in complex traits for her doctorate in genetics at North Carolina State University. She then conducted postdoctoral research on the formation and regulation of neuronal circuits at the Okinawa Institute of Science and Technology in Japan.

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