Rizvi SA et al, 2016: Paediatric urolithiasis in emerging economies.
Rizvi SA, Sultan S, Zafar MN, Aba Umer S, Ahmed B, Naqvi SA.
Department of Paediatric Urology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan.
Department of Pathology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan.
Department of Urology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan.
BACKGROUND: Paediatric urolithiasis remains endemic in low resource countries. This review highlights the epidemiology, causation and management of urolithiasis in an Asian country in the context of emerging economies.
METHODS: A literature review of recent articles with key words paediatric urolithiasis, developing countries, endemic stone disease, stone composition, metabolic risk factors, management of paediatric urolithiasis was undertaken and 51 relevant articles were selected with the main focus on experience of this center in managing stone disease in the last two decades.
RESULTS: Prevalence of paediatric urolithiasis is high upto 15% affecting children under 15 years with male predominance. Bladder stones still constitute 10-70% of the burden. Etiology remains unknown where 55% are considered idiopathic, 25% metabolic, 7% infection and 12% due to anatomical abnormalities. Hot climate, poor nutrition, diarrheal diseases are the major causative factors. Chemical composition of stones showed CaOX in 30-63%, AAU in 17-55%, struvite in 8-9%, uric acid in 3-6% and cystine in 1%. Important metabolic risk factors are hypocitraturia in 63-87%, hyperoxaluria in 40-43%, hypocalciuria in 20%, hyperuricosuria in 27%, hyperammonuria in 11-51% and hypovolemia in 31%. Minimally invasive surgery is the mainstay of surgical management. ESWL provides excellent free rates of 84% for smaller stones. PCNL is the option for majority of renal stones with success rates of 89% for simple and 71.5% for complex stones. For bladder stones PUCL and PCCL success rates were 100%. URS for ureteric stones showed clearance rate of 90%. Open surgery is required in 12% of patients with large stone burden.
CONCLUSION: Paediatric urolithiasis remains a devastating health problem in low resource settings. MIS offers relief to majority of patients with excellent stone free rates and short hospital stay. Preventable strategies have to be put in place by improving nutrition and eliminating risk factors by diet and medical intervention.
Int J Surg. 2016 Nov 16. pii: S1743-9191(16)31094-9. doi: 10.1016/j.ijsu.2016.11.085. [Epub ahead of print]
This review is partially based on the authors experience with a paediatric urological workload of 21,390 patients from 1998 to 2015 with 62% urolithiasis cases, many of them complex “To avoid repeated anesthesia and renal damage, we recommend ESWL where complete clearance is expected in single session.” Based on that recommendation the frequency of the different stone removal procedures is detailed in a table (adapted from the original publication):
Management of paediatric urolithiasis in two eras.