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.

Kidney stones in children and teenagers in the central coast region of Tunisia.

OBJECTIVE: 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. METHODS: 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. FINDINGS: 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. CONCLUSION: 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.

Contribution of laparoscopy in the abdominal tuberculosis diagnosis: retrospective study of about 11 cases.

OBJECTIVE: Abdominal tuberculosis is one of the most frequent extra-pulmonary localizations. Its diagnosis is difficult and may lead to a delayed prescription of specific treatment. This study is aimed at stressing the role of laparoscopy associated with a biopsy in the diagnostic confirmation of abdominal tuberculosis particularly in doubtful cases. METHODS: The diagnostic features of 11 cases hospitalized for abdominal tuberculosis in the Paediatric Surgery Department of Fattouma Bourguiba Hospital in Monastir for a 6-year period (2001-2006), were evaluated retrospectively. The diagnosis of abdominal tuberculosis was substantiated histopathologically by laparoscopy in all cases. The epidemiological and clinical characteristics along with the laboratory, radiological and histological data were studied. RESULTS: Eleven cases of abdominal tuberculosis with a mean age of 5.6 years were diagnosed. It was peritoneal tuberculosis in all cases and associated with intestinal localization in one case. A conversion to laparotomy was practiced in three patients: appendicular plastron in one case, pseudo-tumor aspect of an intestinal loop in another case and because of their pathological aspect appendicectomy and caecum biopsy in the third. The diagnosis was confirmed histologically by biopsies in nine cases and on excision pieces in the other two cases. All patients had an uneventful course with an antituberculosis treatment. CONCLUSION: Abdominal tuberculosis is still frequent in Tunisia. Because of its non-specific clinical presentation and the limited means of investigation, a laparoscopy with biopsy should be practiced as first line diagnostic tool in case of doubtful abdominal tuberculosis. The earlier the diagnosis is established and an adapted antituberculosis treatment is started, the better the prognosis is.

[Urolithiasis in children in Tunisia: current features based on a series of 104 cases]. / La lithiase urinaire de l'enfant en Tunisie. Aspects actuels a propos de 104 cas.

UNLABELLED: The clinical and laboratory characteristics of urolithiasis in Tunisian children have evolved continuously since the 1980s. This retrospective study defines the current status of urolithiasis in children in Tunisia. PATIENTS AND METHODS: All 104 children (age: 8-192 months) of our series were hospitalized for urolithiasis. A first-line metabolic, urine and plasma work-up was performed in 96 patients. Physical and chemical analysis of the stones was performed by stereomicroscopy and infrared spectroscopy, respectively. Statistical analysis of the results was performed with SPSS 11.0 software. The Chi-square test was used for comparison of percentages. RESULTS: Our study shows a male predominance of urolithiasis with a sex ratio of 1.53. The clinical features were dominated by urinary tract infections (28.8%). Stones were situated in the upper tract in 75% of cases and the lower tract in 25% of cases. Urine culture was positive in 15 patients. Identification of the crystalline composition showed that whewellite was the most frequent crystalline species in children (80.0%) and infants (57.1%). Ammonium acid urate was more frequent in infants. CONCLUSION: In this study, we observed changes in the epidemiological characteristics (bladder stones and infection stones) of urolithiasis in children over the last decade in Tunisia. The patient's age is an important factor that must be taken into account during aetiopathogenic work-up.

[Treatment of urinary stones in infants]. / Traitement de la lithiase urinaire du nourrisson.

Up until the beginning of the 1990s, surgery was the only available modality for the treatment of renal and ureteric stones in infants. From 1990 onwards, two new minimally invasive techniques were developed, leading to a real revolution in the management of these patients. The first and most spectacular breakthrough was extension of the application of ESWL to this age-group and the second breakthrough was ureteroscopy following the enormous technological progress in the manufacture of endoscopes. This technique is increasingly useful when lithotripsy is impossible or insufficient. Surgery is still indicated in the case of contraindications to minimally invasive methods or after failure of these methods. It is the method of choice for bladder stones. Medical treatment or watchful waiting have valuable indications, at the cost of regular clinical and radiological follow-up of patients. The choice of treatment modality depends on the size of the stone, its site, its composition, the anatomy of the urinary tract and the availability of the various techniques.

[Rhabdoid tumour of the kidney in children]. / Tumeur rhabdoïde du rein chez l'enfant.

Rhabdoid tumour of the kidney is an extremely rare cancer in children, which raises aetiopathogenic, diagnostic and therapeutic problems. Treatment of this tumour is not well defined and its prognosis remains poor despite progress in paediatric oncology. The authors report a new case of neonatal rhabdoid tumour of the kidney, with a rapidly fatal outcome and present a review of the literature.

[Psoas abscess in children based on a series of 18 cases]. / Abcès du psoas chez l'enfant. A propos de 18 observations.

OBJECTIVE: Psoas abscess is very rare in children and raises problems concerning the clinical and aetiological diagnosis. The authors describe the characteristics of this rare disease and emphasize the role of imaging in the diagnostic approach and therapeutic management. MATERIAL AND METHOD: The authors report a series of 18 cases children aged 11 months to 13 years treated between 1988 and 2000 in the Monastir department of paediatric surgery. The time to diagnosis ranged from 4 days to 1 month. The clinical features comprised fever, abdominal pain and functional impairment of the homolateral lower limb in 17 cases. RESULTS: Ultrasound was performed systematically and established the diagnosis in 17 cases. Computed tomography, performed in 13 cases, confirmed the diagnosis and demonstrated the aetiology in 3 cases. The microorganism was isolated in 16 cases (Staphylococcus aureus in 13 cases). An aetiology was identified in 4 cases: acute appendicitis, Potts disease, sacro-iliitis and perirenal abscess. Treatment comprised systematic antibiotic therapy combined with drainage of the abscess in 16 cases, which was performed surgically in 4 cases and percutaneously in 12 cases. CONCLUSION: The prognosis of psoas abscess in children is generally favourable. CT- or ultrasound-guided percutaneous drainage is a valuable alternative to surgery, which must be reserved for cases of failure of percutaneous drainage.

[Xanthogranulomatous pyelonephritis. Diagnostic and therapeutic problems. Report of three paediatric cases]. / Pyélonéphrite xanthogranulomateuse. Difficultés diagnostiques et thérapeutiques. A propos de 3 cas pédiatriques.

Xanthogranulomatous pyelonephritis (XGP) is an unusual and rare form of chronic renal suppuration in children, which appear to have a multifactorial pathogenesis. It is usually diffuse, but can remain localized to one part of the kidney, resulting in a misleading pseudoneoplastic appearance raising a problem of differential diagnosis with the other renal masses, particularly Wilms tumour. The authors present a retrospective analysis of three cases of XGP observed in the Monastir department of paediatric surgery. The preoperative diagnosis was pyonephrosis with perirenal abscess in two cases and Wilms tumour in the third case. The diagnosis of XGP was established on histological examination of the operative specimens. The aim of this study is to emphasize the diagnostic difficulties of this disease that, in localized forms, often lead to inappropriate treatment and to establish a treatment regimen for this rare disease.