Treatment of pediatric urolithiasis in Iraq: five-year study

ABSTRACT

To report our experience with the management of childhood urolithiasis during a 5 year period. Between April 1999 and April 2004, 204 children with urolithiasis were prospectively evaluated, treated, and followed up in a university hospital in Baghdad. There were 150 males [73.5%] and 54 females [26.5%]. There was a history of previous stones in 73 [35.8%]. Stones were located in multiple sites in 80 children. Metabolic disorders were present in 58 [72.5%] of those with multiple sites. Etiology for stone formation was established in 89.7% of cases; 10.3% were idiopathic. Metabolic disorders were detected in 147 patients [72.1%]. Recurrent urinary tract infection was present in 87 patients [42.6%]. Anatomical defects of the renal system were present in 25 patients [12.3%]. The follow up of 156 patients [76.5%] ranged from one month to 5 years [mean= 36 months]. of those 156 patients, surgery was performed on 51. Extracorporeal shock wave lithotripsy [ESWL] was performed in 26, medical therapy was used in 111, and 19 patients were kept on observation. The ultimate stone free rates were 78.7%, 38.5% and 24.3% following surgery, ESWL and medical therapy respectively. Recurrence of stone disease was 19.7% following surgery. Respectively, 46.9% and 11.5% of patients receiving medical therapy, ESWL had no change in stone size. A combined approach with one or more techniques was applied to our patients. Our results indicate that a comprehensive approach to the care of pediatric urolithiasis requires attention to metabolic disorders