Clinical and metabolic factors associated with surgical intervention in pediatric urolithiasis: a multicenter retrospective study

Abstract

Background This study aimed to identify clinical, radiological, and metabolic factors associated with surgical intervention in children with urinary stone disease. Methods This multicenter retrospective study included 1,018 children with urinary stone disease at 21 pediatric nephrology centers in T & uuml;rkiye between January 2014 and January 2024: all 498 who underwent surgery and a purposively selected comparison group of 520 managed without surgery. Firth's penalized logistic regression identified factors independently associated with surgery (730 complete cases, 343 events, 22 terms, 15.6 events per variable). Results The surgical group was older (median 43.0 vs. 12.0 months, p < 0.001). Stone size was the factor most strongly associated with surgery: compared with stones of 1-5 mm, adjusted odds were higher for 6-10 mm (aOR = 9.84, 95% CI: 6.31-15.36) and for stones larger than 10 mm (aOR=64.51, 95% CI: 25.95-160.34), corresponding to predicted probabilities of 22.4%, 66.2%, and 91.6%. General infectious symptoms (aOR = 4.91), ureteral stones (aOR = 2.65), isolated pyuria (aOR = 2.22), stone passage (aOR = 1.94) and hydronephrosis (aOR = 1.88) were also independently associated, whereas vitamin D supplementation was associated with lower odds (aOR=0.44, 95% CI: 0.26-0.74), an exploratory, age-sensitive association. Hematuria with pyuria was not independently associated after adjustment (aOR = 1.36, p = 0.305). Four associations remained significant after control of the false discovery rate; discrimination was high (area under the curve 0.91, optimism-corrected 0.90). Conclusion Stone size was the dominant factor associated with surgical intervention, followed by stone location, infectious presentation, and hydronephrosis. Hematuria with pyuria was not independently associated once stone burden was accounted for. External validation is required before clinical use.