Clinical Pattern of Urinary Stone Disease in Our Setting

Abstract

Objectives:To study the basic clinical pattern of urinary stone disease in our setting.Study design: Descriptive study. Subjects: A total of 257 urolith patients with different stone burden enrolled in the study.Methodology: Structured and standardized history and clinical investigations collected in all of urolith patients. The diagnosis of stone disease was based on history, physical examination followed by KUB x-ray, ultrasonography and IVU .All patients subjected to open stone surgery. The data were analyzed prospectively with outcome measures of gender, stone location, clinical presentation and operative procedures. Results:Out of 257 patients 181 (70.42%) were male and 76 (29.56%) female with male to female ratio of 2.3:1.The age ranged from 1 year to 80 with the mean of 25.8 years. The peak incidence of upper urinary tract stones was in 20-30 years while lower urinary tract stones in both sexes were under 10 years (Table 1). Anatomical distribution of stone showed 116 (45.16%) renal, 21 (8.17%) ureteric, 108 (42%) bladder and 12 (4.66%) urethral calculi ( Table 2). The commonest clinical presentation was that of pain in 67.31% of patients associated with haematuria in 26.7% of cases. Clinical urinary tract infection (UTI) was in 15% and 8.9% of patients had spontaneous stone passage (lithuria). The symptoms of bladder outlet obstruction (BOO) including retention of urine were in 7% of cases. Calculus anuria was in 1.9% of cases and 8.1% patients had asymptomatic stones. Bilithiasis (chole-nephrolithiasis) was in 5% of cases (Table 3). Open stone surgery included 84 (32.68%) simple pylolithotomies, 15 (5.83%) extended pylolithotomies, 6 (2.33%) pylolithotomy and pyloplasty, 5 (1.94%) nephrolithotomy, 6 (2.33%) nephrectomies, 21 (8.17%) uretrolithotomy, Cystolithotomy was 113 (43.96%) cystolithotomy, 2 (0.77%) urethrolithotomy and meatotomy in 5 (1.94%) of patients. Conclusion:Urolithiasis is increasing problem with high frequency of bladder stones and male predominance in our part of Sindh province. Open surgery is still needed to treat the patients where modern and minimally invasive therapeutic modalities are out of reach and non-availability in public sector. Establishment of modern stone clinics in rural setup is the need of today's medical practice.

Age at onset and clinical presentation of urolithiasis in Ajman, UAE

“…et al(20) observed the mean age at onset of urinary stone as 25.8 years which is not consistent with the observation made in the present study. In Iran, the mean age at presentation was 41.5±16.3 years and the peak incidence was between 55 and 65 years (21).Memon et al reported that the male to female ratio in urinary stone disease was 230:100(20).…”

“…In Iran, the mean age at presentation was 41.5±16.3 years and the peak incidence was between 55 and 65 years (21).Memon et al reported that the male to female ratio in urinary stone disease was 230:100(20). Basiri et al who investigated the demographic profile of urolithiasis across Iran observed that male-to-female ratio was 138:100 (21).…”

<p>Urolithiasis: Presentation and Surgical Outcome at a Tertiary Care Hospital in Ethiopia</p>

“…22 Authors reported flank pain, hematuria and dysuria as the main presenting symptoms of urolithiasis, which is also the case in our study. [2][3][4]12,14,25,30 Apart from this, a study conducted by Odzebe et al and Rimtebaye et al found a high rate of acute urinary retention in their review (26.5% and 28.7%). 3,21 This variation can be explained by the high incidence of lower tract stone and obstructive conditions in their patients.…”

“…7 Comparable with this, our study and others also confirmed urolithiasis as a male predominant disease. 2,4,5,9,10,12,13,15,25,26,[28][29][30] Males are assumed to be susceptible to stone formation for reasons such as lithogenic effect of testosterone, uro-genital anatomy which is prone to stasis and engagement in strenuous work which results in dehydration unless adequately replaced. 14,19,24,31 The limited opportunity of women to go to a health facility in our setup was also mentioned as a factor for the male predominance in urolithiasis.…”

Eswl; Extra Corporeal Shock Waves Lithotripsy With and Without Doublej-Ureteric Stent

“…However in the study of Jan Muhammad Memon was reported that Out of 257 patients 181 (70.42%) were male and 76 (29.56%) female with male to female ratio of 2.3:1. 18 In our study there was wide variation of age ranging from a minimum of 15 year to 45 years in both group. The mean age was 32+ 2.1years.…”