NS-AUA 2024 Annual Meeting Abstracts – Pediatrics

Introduction: Pediatric stone disease incidence has increased steadily over the last several years.Several interrelated factors have been proposed to contribute to these epidemiologic trends including increased ambient temperature, body habitus, and food insecurity.Given the significant cohort of children living with food insecurity in the United States, the aim of this study is to explore the relationship between food desert residence and surgical intervention for stone disease in a cohort of pediatric patients.We also discuss a potential new association with pediatric stone disease: psychiatric comorbidity and the medical management of such diagnoses.Methods: Records of pediatric patients who presented to a single tertiary pediatric medical center for nephrolithiasis between 2009 and 2023 were retrospectively reviewed.Patients were included in the study if they were older than five years of age, lacked anatomical predispositions for stone formation, and were regularly consuming a solid diet.Variables studied included demographics, body mass index (BMI), medical comorbidities and family history, procedures performed, and stone burden.Patients' likelihood of living in a food desert was approximated using the United States Department of Agriculture Food Access Research Atlas.Results: Of 572 patients reviewed, 191 pediatric patients (88 male and 103 female) were included in our analysis.Of these, 69.1% (n=132) had undergone ureteroscopy.Fifty-seven patients (28.6%) had a documented psychiatric comorbidity at time of presentation, with attention-deficit/hyperactivity disorder (ADHD) being the most common psychiatric comorbidity treated via medical management (n=25, 43.9%).Our analysis demonstrated a significant association between surgical intervention and medical history of urinary tract infections (UTI) (p=0.038),food desert residence (p=0.002), or increased stone size (p<0.001).Factors associated with longer time between discharge and surgery decision were past medical history of stones (p=0.015),food desert residence (p=0.047), and psychiatric comorbidity (p=0.050).Among patients with psychiatric comorbidities, ADHD diagnosis and stimulant therapy were also significantly associated with longer mean time before procedural intervention (p=0.009 and p=0.02, respectively).Conclusions: In this study, we found a significant association between food desert residence and surgical intervention for pediatric nephrolithiasis.To our knowledge, our study is among the first to assess association between food insecurity and surgical intervention for pediatric nephrolithiasis, as well as a possible relationship between ADHD and surgical management for stones.Given the importance diet plays in medical management of stone development, clinicians should take care to assess food security status of pediatric nephrolithiasis patients.Further research to determine association between ADHD, pediatric nephrolithiasis, and food insecurity is warranted.