Management of Pediatric Urolithiasis in Pakistan: Experience With 1,440 Children

Rizvi, Syed Adib-ul-Hasan; Naqvi, Syeda Uzma; HUSSAIN, Z.; HASHMI, A.; HUSSAIN, M.; ZAFAR, M. N.; SULTAN, S.; MEHDI, H.

doi:10.1097/00005392-200302000-00051

Cited by 26 publications

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“…Pakistan is situated in the middle of Afro-Asian stone belt, a high region of stone incidence. 1 Stone disease is an increasing problem in the Sindh province. 2 Geographic variation in the rates of urinary stones has been observed for many years not only among countries with higher rates in industrialized nations compared with developing and Third World countries 3 Countries of the region show wide variations in prevalence and the site of stone disease.…”

Section: Introductionmentioning

confidence: 99%

Clinical Pattern of Urinary Stone Disease in Our Setting

Memon¹,

Athar²,

Akhund³

2010

Annals KEMU

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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.

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Section: Introductionmentioning

confidence: 99%

Clinical Pattern of Urinary Stone Disease in Our Setting

Memon¹,

Athar²,

Akhund³

2010

Annals KEMU

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“…In total, we included 41 patients (35 boys and 6 girls), with mean age 7.4 ± 3.1 years (range: [2][3][4][5][6][7][8][9][10][11][12][13][14][15] …”

Section: Resultsmentioning

confidence: 99%

“…5 Concerns about PCNL in children include small kidneys, possible deleterious effects on renal function, and the risk of major complications, including sepsis and bleeding. 10 Changes in technique and instrumentation have changed the management of pediatric stone disease. Therefore, PCNL is increasingly being used as monotherapy or in combination with SWL to treat staghorn stones in children.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous nephrolithotomy versus open surgery for treatment of staghorn stones in pediatric patients

El-Nahas

Shokeir

Shoma

et al. 2014

CUAJ

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Cite as: Can Urol Assoc J 2014;8(11-12):e906-9. http://dx.doi.org/10.5489/cuaj.1994 Published online December 15, 2014. AbstractIntroduction: We compare percutaneous nephrolithotomy (PCNL) and open surgery in the treatment of staghorn stones in children. Methods: We retrospectively reviewed the electronic records of children who underwent treatment for staghorn stones between September 2000 and August 2013. They were divided between Group 1 (patients who underwent PCNL) and Group 2 (patients who underwent open surgery). We compared stone-free and complications rates, need for multiple procedures, and hospital stay. Results: The study included 41 patients (35 boys and 6 girls), with mean age 7.4 ± 3.1 years (range: 2-15). Of these 41 patients, 26 had unilateral renal stone and 15 had bilateral renal stones. The total number of treated renal units was 56: 28 underwent PCNL and 28 underwent open surgery. The complication rate was comparable for both groups (32% for open surgery vs. 28.6%, p = 0.771). Multiple procedures were more needed in PCNL group (60.7% vs. 32% in open surgery, p = 0.032). The stone-free rate was 71.4% after PCNL and 78.6% after open surgery (p = 0.537). A significant difference was observed in shorter hospital stay after PCNL (5 vs. 8.8 days, p < 0.001). Our study's limitations include its retrospective design and relatively small sample size. Conclusions: For the treatment of staghorn stones in children, PCNL was comparable to open surgery in complication and stone-free rates. PCNL had the advantage of a shorter hospital stay and open surgery showed a decreased need for multiple procedures.

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“…Several authors showed that ESWL of lower ureteral stones is not as effective as in stones of the upper urinary tract due to certain difficulties in visualizing stones overlying the sacrum (11). According to Hammad et al however, the efficiency of ESWL in the ureter may increase with a higher number of shock waves delivered (12).…”

Section: Commentsmentioning

confidence: 99%

Extracorporeal shock wave lithotripsy in the treatment of pediatric urolithiasis: a single institution experience

et al. 2010

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Purpose: To compare the efficacy and safety of the electromagnetic lithotripter in the treatment of pediatric lithiasis to that of the earlier electrohydraulic model. Results: In the first group, 21/26 children (80.7%) were stone free at first ESWL session. Colic pain resolved by administration of an oral analgesic in 6 (23%), brief hematuria (< 24 h) resolved with increased fluid intake in 5 (19.2%), while slightly elevated body temperature (< 38°C) occurred in 4 (15.3%). Four children (15.3%) failed to respond to treatment and were treated with ureteroscopy. In the second group 18/19 children were completely stone free at first ESWL session (94.7%). Complications were infrequent and of minor importance: colic pain treated with oral analgesic occurred in 1 (5.26%), brief hematuria (< 24 h), resolved with increased fluid intake in 4 (21%) and slightly elevated body temperature (< 38°C) monitored for 48 hours occurred in 6 (31.5%). Statistical analysis showed that electromagnetic lithotripter is more efficacious and safer than the earlier electrohydraulic model. Conclusions: Technological development not only has increased efficacy and safety of lithotripter devices in treating pediatric lithiasis, but it also provided less painful lithotripsy by eliminating the need for general anesthesia.

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Management of Pediatric Urolithiasis in Pakistan: Experience With 1,440 Children

Abstract: The use of ESWL, percutaneous nephrolithotomy and ureterorenoscopy has resulted in treating a large number of children with a short hospital stay and early return to school. Open surgery is reserved only for complex stones.

Cited by 26 publications

References 0 publications

Clinical Pattern of Urinary Stone Disease in Our Setting

Clinical Pattern of Urinary Stone Disease in Our Setting

Percutaneous nephrolithotomy versus open surgery for treatment of staghorn stones in pediatric patients

Extracorporeal shock wave lithotripsy in the treatment of pediatric urolithiasis: a single institution experience

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