Particular aspects in pediatric urolithiasis

Seventy children [6m - 14 ys] having urinary stones living as residents in Saudia Arabia were reviwed over 3 ys period [1991-1994]. The clinical manifestations of upper urinary stones in infancy Include; failure to thrive, anorexia, gastro-intestinal troubles. Interrupted stream [50%], retention of urine [50%], intermittent erection [2.9%], straining [8.6%]; holding and scrubbing of penis [4.3%] were the presentation for lower urinary stones. in the preschool age B.M, vague abdominal pain, frequency and nocturnal enuresis were the most common, presentation, Lion pain was encountered in 60% of the primary school age, while gross hematuria in 10% of cases. Radiological study; all stones were radloopaque except 7 cases. Upper urinary stone showed the highest incrdence [43] cases [38k + 5U.] Lower urinary stones in 15 cases; stone passers in 8 cases while stones in more than one site in 4 cases, Calculi of the same chemical composition presented variable shadows in the K.U.B. anatomical abnormalities were noticed in [7.2%] of cases. 2 with malrotation, 2 with bil. pelvi ureteric obstruction and one case with reflux. The majority of the stones were of mixed nature and ca. oxalate was the main component Urinary tract infection reported in [4.3%]. Metabolic errors could be a trivial process at the time of stone formation as indicated by biochemical profile

Extra corporeal shock wave lithotripsy for the management of paediatric urolithiasis

Between 1992 and 1994, 33 children with urinary calculi [renal, ureters, bladder] were treated in Al-Nour Specialized Hospital and King Fahad Hospital in Holy Makkah and Jeddah [K.S.A.] using lithostar plus 2 for extra corporeal shock wave lithotripsy. Lithotripsy was performed on 28 renal cases; 8 ureteral and 2 bladder stones. The success rate [stone free and fragments 3 mm or less] for renal stones was 81.3% within 3 months and the stone free rate 95.4% after 3 months and auxilliary procedures were performed in 25% of the renal calculi. The success rate for ureteral calculi was 85% within 3 months, the stone free rate was 90.3% after 3 months and auxilliarv procedure were performed in 10% of the ureteral calculi. The over all success rate was 87% within 3 months, stone free rate 95.2% after 3 months, the retreatment 37% and auxilliary procedure were 39%, while 2 children with stone bladder the clearance rate after 3 weeks 100%. Ureterolithotomy was performed in 2 cases while one patient underwent percutaneous nephrostomy to obviate urinary obstruction, 10 patients out 33 children underwent ESWL have developed complications, [Colic 13%, fever 3%, perirenal hematoma 3% and mild hematuria in 6%]

role of an urgent urethrography in the diagnosis and optimal management of anterior urethral injury

Twenty one patients with straddle injuries [thier age ranged from 20- 45 years] underwent urgent urethrography for evaluation of urethral integrity, complete rupture bulbous urethra in 15 patients and simple urethral contusion in other 6 patients. 10 patients were managed by primary urethral reconstruction with supra pubic diversion and the other 5 patients by supra pubic cystostomy as the primary repair for rupture bulbous urethra. Two out of ten patients were managed by primary urethral reconstruction requires further procedure of urethral dilatation, while 3 patients were managed primarily by suprapubic cystostomy required gradual urethral dilatation, two of them visualised internal uretherotomy and only one patient needs surgical excision of strictured part with urethroplasty [end to end anastomosis]. Therefore urgernt urethrography provides, non invasive, simple and accurate diagnostic procedure for the extent of urethral injury, that is necessary for optimal management with the best successful outcome and least morbidity, as well it can eliminate the controversy existed about the result of primary urethral repair in comparison to suprapubic cystostomy as preliminary procedure as it clarifies the extent of urethral injury

Congenital segmental dysfunction of UPJ an important cause of renal pain and problem in diagnosis

Ten patients with long history of intermittent colicy and or dull ache renal pain, average duration 3 years. Most of them were exposed to a lot of non invasive and invasive urologic investigations and treatment modality with no remarkable diagnostic or prognostic value. They underwent the following reassessment [History, Urine analysis, Urine deposits for acid fast bacilli in 3 of them; modified technique of diuretic urography in all and renography in two. Our results showed that the complains is actually concomitant with water overload, severe pain after lasix infusion, pelvic dilatation and delayed emptying. Intraoperatively; adynamic obstruction was documented by intrapelvic infusion, patency of pelviureteric junction. Postoperatively by symptoms amelioration and diuretic urography. Therefore congential segmental dysfunction of P.U.J. is an important cause of renal pain that could not easily be picked up on conventional urography or other invasive procedures and require the attention of the urologist as the disease process can be presented at any age