PURPOSE We conducted a population-based pediatric study to determine the incidence of symptomatic kidney stones over a 25-year period and to identify factors related to variation in stone incidence during this time period. MATERIALS AND METHODS The Rochester Epidemiology Project was used to identify all children (ages <18 years) diagnosed with kidney stones in Olmsted County, Minnesota from 1984–2008. Medical records were reviewed to validate first time symptomatic stone-formers with identification of age-appropriate symptoms plus stone confirmation by imaging or passage. The incidence of symptomatic stones by age, gender, and time period was compared. Clinical characteristics of incident stone-formers were described. RESULTS There were 207 children who received a diagnostic code for kidney stones, 84 (41%) of whom were validated as incident stone-formers. The incidence rate increased 4% per calendar year (p=0.01) throughout the 25-year period. This was due to a 6% per year rise of incidence in children aged 12–17 years (p=0.02 for age x calendar year interaction) with an increase from 13 per 100,000 person-years in 1984–1990 to 36 per 100,000 person-years in 2003–2008. Computed tomography (CT) identified the stone in 6% (1/18) of adolescent stone-formers from 1984–1996 versus 76% (34/45) from 1997–2008. The incidence of spontaneous stone passage in adolescents did not increase significantly between these two time periods (16 versus 18 per 100,000 person-years, p=0.30) CONCLUSIONS The incidence of kidney stones increased dramatically among adolescents in the general population over a 25-year period. The exact cause of this finding remains to be determined.

Compared to the literature we found a notably lower success rate for robot-assisted laparoscopic extravesical ureteral reimplantation in the hands of 5 fellowship trained, robotically experienced pediatric urologists. More than 10% of patients required at least 1 reoperation for persistent vesicoureteral reflux or a surgical complication. Our experience suggests a higher complication rate and a lower success rate for robot-assisted laparoscopic ureteral reimplantation compared to the gold standard of open reimplantation.

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