Introduction: Pediatric urolithiasis (PUL) is a recurrent condition with a growing incidence worldwide that results in significant patient morbidity and healthcare expenditure. This study evaluated surgical trends and management of PUL in the province of Ontario, Canada from 2002–2018.

Methods: This retrospective cohort administrative database study identified all children (<18 years) who underwent their first surgical treatment for PUL identified using the Canadian Institute for Health Information-Discharge Abstract Database or an Ontario Health Insurance Plan billing. Linked databases held at the Institute of Clinical Evaluative Sciences (ICES) were used to identify variables and outcomes. Descriptive statistics were used to analyze demographics and surgical trends, and logistic regression to identify risk factors for repeat surgical intervention.

Results: A total of 1149 patients underwent a first surgical procedure for PUL (mean age 11.27±5.7 years). The number of surgical procedures performed annually (p=0.059) and PUL surgery incidence rates were relatively stable (p=0.08). There was a trend towards increased use of ureteroscopy (URS) compared to shockwave lithotripsy (SWL) (p=0.145), while percutaneous nephrolithotomy remained stable. Outcomes were reviewed for 706 patients who had an index procedure from 2002–2016 and available followup for at least twoyears; 17.71% had a repeat procedure within six months, predominantly with URS. Renal stone location (odds ratio [OR] 2.79, p=0.0002) and SWL (OR 1.66, p=0.0025) were independent risk factors for repeat surgical procedure within six months. Stone recurrence requiring surgical intervention was 20.4% within five years.

Conclusions: The overall rate of surgically treated PUL was stable in Ontario, Canada from 2002–2018. URS was the most common surgical treatment modality, and a decline in SWL rates was observed reflecting similar trends noted in adults. PUL was associated with a high surgical re-intervention rate within six months.