Yaqoot Jehan, Wajeehuddin, Jalal Akber, Tayyaba Batool.
Clinical profile of children with urolithiasis and their management.
Pak Paed J Jan ;31(3):149-53.

Objective: To find out the clinical profile of patients with urolithiasis and to document their management. Design: Analytical study. Place & duration: Baqai Medical University, Karachi, during the years 2005-2006. Patients & Methods: All children presenting with urinary tract stones during the study period were enrolled into the study. They were all belonged to the vicinity of Baqai hospital. Their hospital record was reviewed for age, sex, clinical symptoms, location of stones and surgical procedures performed. In all cases CBC, blood urea, serum creatinine and electrolytes, urine DR, and culture sensitivity, x-ray KUB and ultrasound were done. IVP was performed in selective cases. Stones were sent for chemical analysis where feasible. Results: In 2 years study period 60 patients were diagnosed as having urolithiasis. All belonged to lower socioeconomic group. Fifty patients were male, with male-female ratio of 5:1. Patients` age ranged from 9 months to 12 years. The largest group of patients belonged to age group of 1-5 years (n=35). Only one patient was nine months old. Twenty four patients were more than 5 years of age. Forty seven (94%) patients had vesical calculi. Urethral calculi were present in 5(8.3%) whereas 4(6.6%) patients had isolated renal calculi. Two (3.3%) patients had both vesical and renal stones. One patient had combined vesical and ureteric stones and 1 had an isolated ureteric stone. Two patients were left against medical advice without surgery (1 renal and 1 with bladder stone). All calculi were radio opaque ( x-ray KUB). Fifty six patients underwent surgical procedures. In 48 cases cystolithotomy was done including three cases of impacted urethral stones, which were pushed back into the urinary bladder and then removed. Meatotomy was done in one case of impacted urethral stone while one case was referred to some other urological specialty as the stone was impacted and attempts to push the stone backwards with the help of bougie failed. One patient with very tiny vesical calculus passed stone spontaneously per urethra. All patients with renal calculi (n=5) underwent pyelolithotomy. In 2 patients with ureteric stones ureterolithotomy was performed. No surgical complication encountered. In 27(48%) patients stones were analyzed for their chemical composition. All were containing calcium oxalate as their major component while a few also contained phosphate, ammonium, urate and magnesium in combination with calcium oxalate. Conclusion: Lower urinary tract calculi occur more frequently than upper tract and Calcium oxalate was the main chemical component present in the stones analyzed.

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