|Year : 2000 | Volume
| Issue : 1 | Page : 20-23
Paediatric urolithiasis in western orissa - a 10-year study
LK Sahu, D Hota, JK Sahu, Sandip Haldar, Kaushik Sil
Department of Urology, S.C.B. Medical College, Cuttack, India
L K Sahu
Department of Urology, S.C.B. Medical College, Cuttack - 753 007
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Only a very few reports are available in the world literature and almost no report are available in our country regarding urolithiasis in children. The incidence of urolithiasis is much more common in the western part of Orissa compared to other parts. This study was conducted during the last 10 years, i.e., from January 1988 to January 1998, to throw light on the different aspects of paediatric urolithiasis.
The incidence was found to be high (8.41 %) with a male preponderance (male: female, 29: 1). Children below 10 years of age were the common victims. This disease was found to be more common in lower socio-economic status group, which is used to cheaper non-vegetarian diet. In the absence of facilities for ESWL and endoscopic stone removal, open surgery was the choice of the treatment.
Keywords: Paediatric Urolithiasis; Urolithiasis in Children.
|How to cite this article:|
Sahu L K, Hota D, Sahu J K, Haldar S, Sil K. Paediatric urolithiasis in western orissa - a 10-year study. Indian J Urol 2000;17:20-3
| Introduction|| |
Review of world literature indicates that only a few reports are available regarding urolithiasis in children. Almost no report is available indicating study of paediatric urolithiasis in our country. Incidence of urolithiasis, as a whole, is much more common in the western part of Orissa, compared to other parts. This study was conducted with an attempt to throw light on the incidence, possible etiological factors, clinical manifestations and management of urolithiasis in children of Western Orissa during a period of 10 years (January 1988 to January 1998).
| Materials and Methods|| |
During the period from January 1988 to January 1998, a total number of 713 new paediatric patients came to the V.S.S. Medical College Hospital, Burla, for urological services. Out of them 60 patients (8.41%) resented with symptoms of stone in the urinary tract [Figure 1]. All these patients were fully investigated with routine haematological, biochemical and radiological investigations for urolithiasis.
Out of these 60 patients, 30 were either lost to followup or were unwilling for surgery. The rest 30 patients were subjected to suitable surgical management with a followup period ranging from 6 months to 10 years. This study exclusively deals with urolithiasis in these 30 paediatric patients having stones located in 32 positions.
| Results and Discussion|| |
The incidence of urolithiasis in children was found to be 8.41 %, of the total number of paediatric patients coming for urological services. Hassan et al  and Borgmann et al  reported the incidences of paediatric urolithiasis to be 0.0096% and 1.5% respectively. Such a high incidence of urolithiasis in the western part of Orissa might be attributed to extreme temperature during summer, dehydration and urinary concentration, extreme scarcity of drinking water particularly in summer, poverty and poor nutritional status resulting in deficiencies of vitamins A and B 6 and frequent dysentery and other diarrhoeal disorders.
The age incidence has been shown in [Figure 2]. The average age at diagnosis was found to be 7.43 years and maximum number of patients (63.38%) was less than 10 years. The incidence of urolithiasis below the age of 10 years was found to be 86.66%. This could be related to an increased incidence of urinary tract infection in that age group as postulated by Daischner et al. 
The study revealed a much higher incidence of urolithiasis in male children (96.66%) than females (3.33%). Thus the male-female ratio was found to be 29:1. Our findings of the sex incidence of paediatric urolithiasis contradicts the findings of Reza et al  and O' Regan et al  in which the male-female ratio were 2:1 and 1:1 respectively. But Borgmann et al  came across a higher incidence of urolithiasis in male children than female (18:1).
It was very important to note that this study revealed a higher incidence of urolithiasis (83.33%) in lower socioeconomic group compared to higher socio-economic group (16.67%). We agree with Hassan et al  that the possible cause for this could be poverty, leading to malnutrition, deficiencies of vitamins A and B 6 and diarrhoeal disorders. The incidence was also found to be much higher (86.64%) in patients used to cheaper non-vegetarian diet like dry fish and pork, than those used to vegetarian diet (13.3%). Rich contents of phosphates and purines in animal proteins could be the possible cause for the above findings. Majority of the patients (60%) presented with pain in the abdomen. Dysuria (40%) and haematuria (36.66%) were less common modes of presentation. 7 of our patients (23.33%) presented with acute retention of urine, due to stones impacted in the urethra. Common presenting symptoms have been shown in [Table 1].
Urolithiasis was associated with moderate to severe degree of urinary tract infection in 66.6% patients whereas the urine was sterile in the rest. In majority of the cases (65%), E.coli was found to be the offending organism [Table 2].
Calculi in the lower urinary tract were found to be more common (68.75%) than that in the upper tract (31.25%) [Table 3]. Hassan et al  and Khalil et al  suggested that the lower urinary tract calculi were more common in developing countries due to malnutrition and diarrhoeal diseases, whereas incidence of stone in upper tract is more common in developed countries because of metabolic disorders and urinary tract anomalies.
In the absence of facilities for ESWL, PCNL or endoscopic stone retrieval, open surgery was undertaken as shown in [Table 4].
| Conclusion|| |
A study on paediatric urolithiasis for a period of 10 years had been conducted in Western Orissa. This study showed a much higher incidence of stones in children. Male children are much more prone to this disease than their female counterparts. There was a higher incidence of stone below 10 years of age. Children belonging to lower socioeconomic strata were the victims in majority. The lower urinary tract was found to be more commonly the seat of stones than the upper tract. In absence of sophisticated facilities, open surgery was indicated.
| References|| |
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|3.||Daeschner CW, Singleton EB, Curtis JC. Urinary tract calculi and nephrocalcinosis in infants and children. J Paediatr 1960: 57: 721-731. |
|4.||Malek RS. Kelalis PP. Paediatric Nephrolithiasis. J Urol 1975: 113: 545-551. |
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[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3], [Table 4]