The absence of guidelines for appropriate management of stones in children is clearly a major problem that has resulted in great variability.
It is true that throughout the United States, there appears to be a rising incidence of stones in children. It is also true that the minimally invasive techniques that are applicable to adults can be usually adapted to children, allowing them to receive much more effective care with less morbidity than in the past. However, the absence of guidelines for appropriate management is clearly a major problem that has resulted in the great variability that this study reports.
In my opinion, it is difficult to escape the conclusion that inappropriate interventions are being carried out, at least some of the time. We should, for a defined problem like pediatric urolithiasis, have clear-cut guidelines that are evidence based and permit a choice of therapy that will be demonstrable to all payers to be the most cost-effective way to deal with a given medical problem.
Ultimately, this will enhance the care of children and adults alike.
Dr. Snyder, a member of the Urology Times Editorial Council, is professor of surgery in the department of urology at the University of Pennsylvania School of Medicine, Philadelphia.