Introduction:
Childhood urolithiasis or urinary tract stones is common problem in children.The causes are anatomical abnormalities of urinary tract giving rise to stasis of urine, urinary infection, change in pH of urine etc.
Classification:
1. Anatomic
Pelviureteric junction obstruction
Vesicoureteral reflux
Neurogenic bladder
Extrophy of bladder
Ureterocele
Urethral diverticulum
2. Infection:
Stasis of urine causes infection. These infective stones are called as struvite stones.
3. Metabolic:
Cystinuria
Hyperoxaluria
Renal tubular acidosis
Urine acid stones
Hypercalciuria
4. Idiopathic:
In 20% of cases the exact cause of urolithiasis is unknown. Low intake of milk/animal proteins may be one of the cause.
Clinical presentation: Girls> Boys
1. Colicky pain in abdomen
2. Frequency of urination
3. Hematuria
4. Recurrent UTI
5. Passage of stones in urine
Diagnosis:
1. Urine Routine & Microscopy
2. Urine Culture
3. Serum Electrolytes
4. Serum Uric Acid
5. Serum Creatinine
6. Serum Calcium
7. Serum phosphorus
8. Serum Magnesium
9. Ultrasonography- Abdomen & Pelvis
10. Intravenous Pyelography
11. CT Scan Abdomen in some cases)
Treatment:
1. Conservative - in tiny stones. Plenty of liquids orally with antibiotics or IV fluids with diuretics
2. Extracorporeal Shock Wave lithotripsy - ESWL- It is used in renal pelvic stones, calyceal stones or upper ureteral stones which are less than 2 cm in diameter.
3. Percutaneus nephrostolithotripsy- Percutaneus access of calyx by making a puncture then tract is dilated with serial dilators. This tract is used to for use of lithotripter. The PCNL is used for stones more than 2 cm or hard stones. It is also used in combination with ESWL.
4. Ureteroscopic extraction of stone- small stones in lower ureters can be removed with ureteroscopic extraction.
5. Cystolithopaxy- Transurethral defragmentation of bladder stones with electrohydraulic lithotripter.
6. Open surgeries like nephrolithotomy or cystolithotomy.
