Background and objectives The prevalence of nephrolithiasis in the United States has increased substantially, but recent changes in incidence with respect to age, sex, and race are not well characterized. This study examined temporal trends in the annual incidence and cumulative risk of nephrolithiasis among children and adults living in South Carolina over a 16-year period.Design, setting, participants, & measurements We performed a population-based, repeated cross-sectional study using the US Census and South Carolina Medical Encounter data, which capture all emergency department visits, surgeries, and admissions in the state. The annual incidence of nephrolithiasis in South Carolina from 1997 to 2012 was estimated, and linear mixed models were used to estimate incidence rate ratios for age, sex, and racial groups. The cumulative risk of nephrolithiasis during childhood and over the lifetime was estimated for males and females in 1997 and 2012.Results Among an at-risk population of 4,625,364 people, 152,925 unique patients received emergency, inpatient, or surgical care for nephrolithiasis. Between 1997 and 2012, the mean annual incidence of nephrolithiasis increased 1% annually from 206 to 239 per 100,000 persons. Among age groups, the greatest increase was observed among 15-19 year olds, in whom incidence increased 26% per 5 years (incidence rate ratio, 1.26; 95% confidence interval, 1.22 to 1.29). Adjusting for age and race, incidence increased 15% per 5 years among females (incidence rate ratio, 1.15; 95% confidence interval, 1.14 to 1.16) but remained stable for males. The incidence among blacks increased 15% more per 5 years compared with whites (incidence rate ratio, 1.15; 95% confidence interval, 1.14 to 1.17). These changes in incidence resulted in doubling of the risk of nephrolithiasis during childhood and a 45% increase in the lifetime risk of nephrolithiasis for women over the study period.Conclusions The incidence of kidney stones has increased among young patients, particularly women, and blacks.

Purpose Results following distal hypospadias repair are favorable. Grouping proximal and distal hypospadias repair artificially increases the perceived success rate of proximal hypospadias. We identified our complication rate of proximal hypospadias repair and hypothesized a higher complication rate for 1-stage repair. Materials and Methods We retrospectively reviewed the records of consecutive boys who underwent proximal hypospadias from 2007 to 2014. Proximal hypospadias was defined as a urethral meatus location at or more proximal than the penoscrotal junction after penile degloving. We further stratified boys into those with planned 1-stage vs 2-stage repair. Univariate and Cox regression analyses were performed to assess associations with covariates and compare time to the first complication, respectively. Results A total of 167 boys met study inclusion criteria. Median followup was 31.7 months for 1-stage repair in 86 patients and staged repair in 81. The overall complication rate was 56%. Complications developed in 53 of 86 1-stage (62%) vs 40 of 81 staged (49%) repairs (p = 0.11). The number of unplanned procedures per patient was higher in the 1-stage than in the staged group (0.99 vs 0.69, p = 0.06), as was the number of patients who had at least 2 complications (29 of 86 or 33% vs 13 of 81 or 16%, p = 0.03). Cox regression showed no difference in time to the first complication for staged compared to 1-stage repair (HR 0.77, 95% CI 0.43–1.39). Conclusions Our 56% complication rate of proximal hypospadias warrants further long-term patient followup. More patients in the 1-stage group experienced at least 2 complications. However, when complications developed, they developed no differently in the 2 groups.

Purpose Nephron-Sparing Surgery (NSS) is the standard of care for many adults with renal tumors and has been described in some children with Wilms tumor (WT). Beyond case series, however, data concerning NSS utilization and outcomes in WT are scarce. Using a large cancer data registry, we examined NSS outcomes and factors associated with NSS use in WT. Materials and Methods We retrospectively reviewed the 1998–2010 Surveillance, Epidemiology, and End Results (SEER) database. We identified WT patients aged ≤ 18 years. Clinical, demographic and socioeconomic data were abstracted, and statistical analysis was performed using multivariate logistic regression (predicting use of NSS) and Cox regression (predicting Overall Survival, OS) models. Results We identified 876 boys and 956 girls with WT (mean age 3.3 ± 2.9 years). Of these, 114 (6.2%) underwent NSS (74 unilateral, 37 bilateral WT). Median follow up was 7.1 years. Regarding procedure choice, NSS was associated with unknown lymph node status (NX vs N0, p<0.001) and smaller tumor size (p<0.001). Regarding survival, only age (HR=1.09, p=0.002), race (HR=2.48, p=0.002), stage (HR=2.99, p<0.001), and LN status (HR=2.17, p=0.001) predicted reduced OS. Survival was not significantly different for children undergoing NSS vs. RN (HR=0.79, p=0.58). Conclusions Among children with WT included in the SEER database, NSS is infrequently performed. NSS use is associated with smaller, bilateral tumors and with omission of lymphadenectomy; however, there are no evident differences in NSS use by demographic or socioeconomic factors. Despite lymph node under-staging, overall survival after NSS remains similar to radical nephrectomy.

Use of EPU stents provided a viable alternative, particularly in younger patients, to DJ stenting with comparable success and complications, while avoiding the need for an additional anesthetic.

Background The impact of race and socioeconomic status (SES) in prostate cancer (CaP) outcomes has been well-studied, but controversy remains. We explored in an equal-access setting the associations of race/SES with intermediate CaP outcomes including positive surgical margin (PSM) and biochemical recurrence (BCR). Methods Data were retrospectively collected from 2502 men in the Shared Equal-Access Regional Cancer Hospitals (SEARCH)database who underwent radical prostatectomy from 1989–2010. SES (income, education, employment, and poverty) was estimated from linkage of home zip-code to census data. Logistic regression with adjustment for pre-and post-operative covariates estimated risk for associations between race/SES and pathologic outcomes. Cox proportional hazards models estimated risk for associations between race/SES and time to BCR. Results Black men were more likely to have lower SES than white men (p<0.001). On multivariate analysis, race was not associated with PSM, but higher SES was associated with less PSM and fewer Gleason sum ≥ 7 pathologic tumors when SES was assessed by education, employment, or poverty (p-trend ≤ 0.051) and income, employment, or poverty (p-trend ≤ 0.059), respectively. Crude Cox models showed black men had higher BCR risk (Hazards Ratio [HR] 1.20, 95% Confidence Interval [CI] 1.05–1.38, p=0.009) that persisted after adjustment for covariates including SES (HR ≥ 1.18, p ≤ 0.040). Higher SES measured by income and poverty were associated with less BCR but only for black men (p-trend ≤ 0.048). Conclusions Even in an equal-access setting, higher SES predicted lower PSM risk, and race persisted in predicting BCR despite adjustment for SES. Low SES black patients may be at greatest risk for post-prostatectomy BCR.

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Opinion Statement Pediatric stone disease is increasing in incidence and healthcare costs. With more years at-risk for stone recurrence during their lifetimes, children with nephrolithiasis constitute a high-risk patient population that requires focused intervention through both medical and surgical means. Through high-quality future studies to compare methods of stone prevention and treatment, the burden of stone disease on the youngest members of society may be ameliorated.

BACKGROUND AND OBJECTIVE: Quality improvement in surgery involves identifying patients at high risk for postoperative complications. We sought to assess the impact of race and procedure type on 30-day surgical morbidity in pediatric urology.