[Epidemiological changes of paediatric urolithiasis in Tunisia]

The clinical and biological characteristics of urolithiasis in children are still evolving in our country. Since the eighties no study has been conducted to determine incidence of urolithiasis in Tunisia. To define the current status of urolithiasis inTunisian children. The records of 414 children with urolithiasis treated between 1983 and 2007 were found in a multi-centric study which took into consideration to age, sex, and history diagnosis and physical, laboratory, and radiologic findings. Clinical and biological date were performed in 344 cases. Stone analysis was performed by spectrophotometry. The incidence of paediatric urolithiasis has steadly decreased from 0.7/ 10 000 of the child population / year in 1991-1994 to 0.1 cases/10 000 children/ year in 2007. There was a continuous decrease in bladder stone over the past 25 years [47.1% in 1982-1986 Vs 10.2% in 2002-2007]. Stones were homogeneous in 31.4% of cases. The main component was calcium oxalate stones in 36.4% of the cases. Since the eighties the increase of oxalates stones [15.6% in eighties Vs 51.5% actually] were with depends to purines and struvite stones. Epidemiologic characteristics of the urinary lithiasis [sex, age, localization and composition] have changed in Tunisia, due to the improvements of standard of living. The occidentalization of the nutritional practices and the receding of the culinary traditions gave birth to new risks of urolithiasis characterized by the emergence of calcium oxalate stones

Kidney stones in children and adolescents in the central coast region of Tunisia

Since 1980s, the clinical and biological characteristics of urolithiasis in Tunisian children have continuously evolved. This retrospective study defines the current status of urolithiasis among children and adolescents in Tunisia. We retrospectively reviewed the records of 310 children and adolescents [age: 3 months - 19 years] between 2003 and 2010, holding urolithiasis. A first-line metabolic, urine and plasma work-up was performed in all patients. Physical and chemical analysis of the stones was performed respectively by stereomicroscopy and infrared spectroscopy. Statistical analysis of the results was performed with SPSS 11.0 software. The Chi-square test was used for comparison of percentages. Our study shows a male predominance of urolithiasis with a sex ratio of 1.5. Stones were located in the upper urinary tract in 70.7% of cases. Calcium oxalate was the predominant constituent in 52.6% of stones. There was an increasing prevalence of calcium oxalate stones according to age in both genders [48.6% in infants vs 68.5% in teenagers [P<0.01]]. Struvite was more frequent in patients aged 2-9 years [P<0.02] and significantly more prevalent in boys than in girls [P<0.001]. Ammonium urate stones were observed in 14.2% and were more frequent in infants. Our results emphasize a high percentage of calcium oxalate stones and a low percentage of struvite stones. The persistence of urate stones reflects the particular eating habits and the infectious risk factors. The patient's age is an important factor that must be taken into account during etiopathogenic work-up

Changes in Urinary Stone Composition in the Tunisian Population: A Retrospective Study of 1,301 Cases

BACKGROUND: Studies that evaluate the effect of age on stone composition are scarce. The aim of this study was to highlight the changes in epidemiological characteristics (stone composition and location) of urolithiasis according to patients' age. METHODS: We studied 1,301 urolithiasis patients with age ranging from 6 months to 92 yr (781 males and 520 females). Stone analysis was performed using a stereomicroscope and infrared spectroscopy to determine the morphological type and molecular composition of each stone. RESULTS: The annual average incidence of new stone formation was 31.7 per 100,000 persons. In 71.8% of cases, calculi were located in the upper urinary tract. Compared to other age groups, children and old men were more affected by bladder stones. Calcium oxalate monohydrate was the most frequent stone component, even though its frequency decreased with age (59.5% in young adults and 43.7% in the elderly, P<0.05) in favor of an increase in uric acid stones (11.5% in young adults and 36.4% in the elderly, P<0.05). Struvite stones were rare (3.8%) and more frequent in children than in adults. CONCLUSIONS: The analysis of these data showed that urinary stones in Tunisian patients are tending to evolve in the same direction as the stones in patients from industrialized countries.

Pediatric urolithiasis in coastal Tunisia

We will try to show an outline of the clinical and biological characteristics of pediatric urolithiasis among Tunisian children in the coastal region. This retrospective study included 168 children below 16 years [100 boys and 68 girls] presented with urinary stones. Patients were reviewed in a multi-centric study with regard to age at diagnosis, sexual, historical, physical, laboratory, and radiologic findings. The physical and chemical analysis of stones was carried out by a stereomicroscope and infra-red spectroscopy respectively. Statistical analysis of data was carried out using software SPSS 11.0 for Windows. Statistical significance was determined using chi-square test. The sex ratio was 1.47. Clinical presentation of this pathology was dominated by abdominal pain [28%], hematuria [25.6%], dysuria [16.7%] and urinary tract infection [14.3%]. Stones were located in the upper urinary tract in 75.6% of cases. Of the urine cultures, 14.3% were positive. Whewellite is found more frequently in children stones than infants [P < 0.05] and was the main component in 46.4% of stone section and 55.4% of stone surface. Stuvite stones were more frequent among boys stones than girls' [11 Vs 2.9%] [P < 0.05]. The male prevalence of pediatric urolithiasis is less obvious in Tunisia. Calcium oxalate is the most frequent chemical compound in Tunisian pediatric urolithiasis