Objectives: To determine the pattern, demographic features, clinical features, the common types of vesical stones and diagnostic tools accuracy of endemic vesical stone in children.
Materials and Methods: In this study the records of 73 patients with endemic vesical stones were reviewed at Gezira National Center For Pediatric Surgery (GNCPS). The data were analyzed for age, sex, locality, clinical features the diagnostic tools, the treatment offered and outcomes.
Results:&nbsp; A total of 73 patients were included in this study, males were 64&nbsp; (87.7%), &lt; 5 years were&nbsp; 54 cases ( 74%), the majority from rural areas of low socio-economic status. &nbsp;Conclusion: Endemic vesical stones in children is common in males below&nbsp; 5 years&nbsp; and low socio-economic status, with UTI like symptoms and penile itching

Nugud, Faisal A

Osman, Mohanned A M

Osman, Osman T M

English

Journals Of University Of Gezira

EDITORIAL   Gezira Journal Of Health Sciences 2014 vol.10(1)   Gezira Journal Of Health Sciences 2014 vol.10(1)  Endemic Vesical Stones in Sudanese Children Seen at Gezira  National Center for Pediatric Surgery    Mohanned A M Osman1, Faisal A Nugud2 and Osman T M Osman3    1. M.B.B.S Omdurman Islamic University-Part 1 General Surgery SMBS  2. MD, Associate Prof of Pediatric Surgery U of Gezira  3. Prof of Pediatric Surgery U of Gezira  Correspondence to: Mohanned Abd Alkareem Mohamed Osman Idris E mail: faisal nugud2@yahoo.com Phone: 0919302314    Abstract:  Objectives: To determine the pattern, demographic features, clinical features, the common types of vesical stones and diagnostic tools accuracy of endemic vesical stone in children.  Materials and Methods: In this study the records of 73 patients with endemic vesical stones were reviewed at Gezira National Center For Pediatric Surgery (GNCPS). The data were analyzed for age, sex, locality, clinical features the diagnostic tools, the treatment offered and outcomes.  Results:  A total of 73 patients were included in this study, males were 64  (87.7%), < 5 years were  54 cases ( 74%), the majority from rural areas of low socio-economic status.  Conclusion: Endemic vesical stones in children is common in males below  5 years  and low socio-economic status, with UTI like symptoms and penile itching.        Key words: Endemic vesical stone, GNCPS     Introduction:   Endemic bladder calculi virtually disappeared from Northern Europe during the late 19th century,(1) and from Southern Europe by 1970.(2) The endemic bladder calculi have become rare in developed countries due to industrialization  and improvement in nutrition and diet. The incidence of these stones is very low in Central and South America, Central and South Africa. However, these stones remain an important cause of morbidity in an endemic belt extending from the  Middle-east across India and Thailand to Indonesia, including North Africa, whose economics primarily depends on agriculture. This  belt includes Algeria , Sub Saharan  Africa ,Rwanda , Ethiopia, Sudan , and Egypt , through Iraq , Iran , Afghanistan , India , South East Asia , and Indonesia. The stones are more common in India in the northern and western regions as compared to southern and eastern regions.   There is simultaneous increase in upper urinary tract stones .(3,4,5,6,7,8) The incidence has decreased in the Philippines , Taiwan , and Singapore.(9,10,11) However these stones have also been found  in the western Australian region , especially in aboriginal  children .(12)  These stones are typically found in infants and children of lower socio-economic status , children younger than 10 years are most commonly affected , with a peak  incidence around 3 years . The male to female ratio is 10:1. (7,8,13)   Material and Methods:   EDITORIAL   Gezira Journal Of Health Sciences 2014 vol.10(1)   Gezira Journal Of Health Sciences 2014 vol.10(1) This retrospective, prospective study was conducted at GNCPS from June2011June2013. Study involved 73 pediatric patients with endemic vesical stone, diagnosed by US, KUB, treated by open suprapubic cystolithotomy, and stones were analyzed chemically. Data was collected by questionnaire and photographs.   Results:   There were 73 patients, 64 of them were males (87.7%) , giving a male: female ratio of 7.1:1. 21.9% of the patients were among displaced families from urban areas, whereas 78.1% were from distant rural areas. The age distribution was shown in table 1, indicating that 54 patients (74%) were  5 years.  Solitary and oval vesical stones were encountered (figure 1, figure 2).    Clinical presentations: 65 cases (89%) presented with burning micturition . 15 cases (20.5%) presented with haematuria . 13 cases (17.8%) presented with urine retention, . 4 cases (5.5%) presented with suprapubic pain . 11 cases (15.1%) presented with interrupted stream . 33  cases (45.2%) presented with penile itching  .No case in the study  presented with priapism  . 3 cases (4.1%) presented with dribbling of urine table 2.     EDITORIAL  Gezira Journal Of Health Sciences 2014 vol.10(1)   Gezira Journal Of Health Sciences 2014 vol.10(1)       Table 1:  Age distribution        Table 3: Chemical Analysis of stones     Chemical Analysis of stones   Number of cases  Percentage   Uric acid  63  86.3%  Mixed   6  8.2%  Calcium   3  4.1%  Oxalate  1  1.4%  Others  0  0%    EDITORIAL  Gezira Journal Of Health Sciences 2014 vol.10(1)   Gezira Journal Of Health Sciences 2014 vol.10(1)    Figure 1: Ultrasound showing a single vesical stone  Figure 2: KUB showing single oval vesical stone   Discussion:   In this study, out of the 73 patients analyzed; 64 patients (87.7) were males and 9 were females (12.3). Apparently because males have long tortuous urethra where as females have short non tortuous urethra and therefore more likely to pass crystals formed in the bladder before maturing into well formed vesical stones(7,8) . 54 (74%) were below 5 years of age. As reported in the literature  the incidence of pediatric endemic vesical stone is highest during  the first 10  years of  life  with a  peak incidence around the age of 3 years and then decreases thereafter .(13)The findings in this study match those reported in other studies. Most of the patients were from rural locality (78.1%) belonging to poor families with low socioeconomic status (80.8%). This reflects the poor dietary habits, low levels of parental education and limited access to   EDITORIAL  Gezira Journal Of Health Sciences 2014 vol.10(1)   Gezira Journal Of Health Sciences 2014 vol.10(1) health facilities. It is renowned that people in rural communities tend to maintain their children on diet rich in cereals and low in protein, a diet much similar to that fed to children in rural areas in England at a time when vesical stones were rife.(13,14,15,16)  That supported by both the weight and height were found to be below the 30th centile in the majority of children  indicating some degree of malnutrition. This supports the theory of nutritional deficiencies.(13,14,15,16,17,18) .  In this study we recognized four clinical presentations of endemic vesical stones in our patients. The commonest was UTI like symptoms followed by itching and manipulation of the penis, stone impaction resulting in urine retention and haematuria. We did not report any case of endemic vesical stones presenting with priapism or rectal prolapse.           US was the initial diagnostic test ordered to all patients enrolled in this study. It was diagnostic in 63 cases (86.3%). The upper urinary tract was otherwise normal in all patients excluding anomalies of the urinary tract as a cause of the stone. It can then be concluded that US is an excellent tool for diagnosis of endemic vesical calculi.  US is reported to be non expensive, has wide availability, avoidance of radiation  and ability to define the anatomy of  the urinary tract, also can detect stones as small as 1.5 to 2 mm, for stones larger than 5 mm, US has a sensitivity of 96% and specificity of nearly 100%, but it is operator dependent .(19,20). Being cheap is another point of advantage to US.  In our series  open suprapubic cystolithiotomy  was an excellent procedure for stone retrieval; only 2 cases  (2.7%) from the study population developed   complications . It can be stated that open suprapubic cystolithiotomy is a simple and safe procedure that can be performed in a rural hospital with minimal equipment .Open suprapubic cystolithiotomy remains the mainstay of therapy with less complications. (21)  The number of stones extracted at operation: the stone was solitary in 70 cases (95.9 %).  Our finding is consistent with figures quoted from the literature  in that most of endemic vesical stones are solitary. (8,13)   Regarding chemical analysis of stones, most of the stones were uric acid, 63 cases (86.3), as in table 3,  due to rapid tissue turnover in children(which falls back to normal adult concentration by the age of 10years). In literature,  ammonium  acid urate  (ammonium and uric acid) is common also due to rapid tissue turnover in  children.(22)        Reference:  1 Ellis H. A historv of bladder stone. Oxford: Blackwell Scientific, 1969:1-25.  2 Pavone-Maculuso M, Miano L. Epidemiology of urolithiasis in Italy. In 18th Congress de la Societe Internationale d‟Urology, Paris, July 1979, pp. 113-137.   3 Robertson WG. The changing pattern of urolithiasis in UK and its causes. In: Kok DJ, Romijn HC, Verhagen PCMS, et al., eds. Eurolithiasis. Maastricht: Shaker; 2001:9-11  4 Kamardi T, Soemanto M, Rizal A, et al. Epidemiology of bladder stones in West Sumatra. In: Brockis JG, Finlayson B, eds. Urinary Calculus. Littleton: PSG; 1981:195203.   5 Bakane BC, Nagtilak SB, Patil B. Urolithiasis: a tribal scenario. Indian J Pediatr.  1999;66:863-865. CrossRef   6 Rahman MA, Van Reen R. Current investigations of vesical calculus disease in Pakistan. In: Van Reen R, ed. Proceedings of WHO Regional Symposium on Vesical calculus Disease. Washington: US Department of Health, Education and Welfare; 1977:57-67.   7 Robertson WG. Renal stones in the tropics. Semin Nephrol. 2003;23(1):77-87. CrossRef   EDITORIAL  Gezira Journal Of Health Sciences 2014 vol.10(1)   Gezira Journal Of Health Sciences 2014 vol.10(1) 8 Halstead SB. Studies on the epidemiology of idiopathic bladder stone disease. In: Van Reen R, ed. Proceedings of WHO Regional Symposium on Vesical calculus Disease.  Washington: US Department of Health, Education and Welfare; 1977:121-134.   9 Hsu T-C. Petrographic studies on urinary calculi. J Formos Med Assoc. 1962;61:937941.   10 Tambyah JA, Murugasu JJ, Tan IK, et al. Urinary calculi in Singapore – a study of 254 patients. Singapore Med J. 1972;13:269-272.   11 Navarro MD, Guevara BQ. An analytical study by infra-red spectroscopy of the constituents of urinary calculi found among Philippine residents. J Philipp Med Assoc. 1974;50:185-214.   12 Jones TW, Henderson TR. Urinary calculi in children in Western Australia. Aust Paediatr. 1989;25:93-95.   13 Teotia M, Teotia SP. Endemic vesical stone: nutritional factors. Indian Pediatr. 1987;24(2):1117-1121.   14 Robertson WG. Urolithiasis: epidemiology and pathogenesis. In:  Husain I, ed. Tropical Urology and Renal Disease. London: Heinemann; 1982:267-278.   15 Ansari MS, Gupta NP. Impact of socio-economic status in etiology and management of urinary stone disease. Urol Int. 2003;70(4):255-261. CrossRef   16 Brockis JG, Bowyer RC, McCulloch RK, et al. Physiopathology of endemic bladder stones. In: Brockis JG, Finlayson B, eds. Urinary Calculus. Littleton: PSG; 1981:225-236.  17 Anasuya A, Narasinga Rao BS. Studies on the role of nutritional factors in urinary lithiasis. Invest Urol. 1973;10:426-428.   18 Valyasevi A, Halstead SB, Dhanamitta S. Studies of bladder stone disease in Thailand.VI. Urinary studies in children, 2–10 years old, resident in a hypo and hyperendemic area. Am J Clin Nutr. 1967;20:1362-1368.   19. Turrin A, Minola P, Costa F, Cerati L, Andrulli S, Trinchieri A. Diagnostic value of colour Doppler twinkling artefact in sites negative for stones on B mode renal sonography. Urol Res. 2007;35:313–317. doi: 10.1007/s00240-007-0110-8. [PubMed]  20. Varma G, Nair N, Salim A, et al. Investigations for recognizing urinary stone. Urol Res 2009 Dec;37(6):349-52.  21. Mahran MR, Dawaba MS. Cystolitholapaxy versus cystolithotomy in children. J Endourol. 2000;14:423–6.   22 Bowyer RC, Brockis JG, McCulloch RK. The role of common urinary constituents in the precipitation of ammonium acid urate. Clin Chem Acta. 1979;99:221-227. CrossRef    

Endemic Vesical Stones in Sudanese Children Seen at Gezira  National Center for Pediatric Surgery

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Endemic Vesical Stones in Sudanese Children Seen at Gezira National Center for Pediatric Surgery

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