Clinical Pattern of Urinary Stone Disease in Our Setting

Jan Muhammad Memon,Anwar Ali Akhund,M Amin Athar

doi:10.21649/akemu.v15i1.25

Abstract

Objectives: To study the basic clinical pattern of urinary stone disease in our setting.Study design: Descriptive study.Setting: Department of surgery of Nawabshah Medical College Nawabshah over a period of 4 years between August 2003to August 2007.Subjects: A total of 257 urolith patients with different stone burden enrolled in the study.Methodology: Structured and standardized history and clinical investigations collected in all of urolith patients. Thediagnosis of stone disease was based on history, physical examination followed by KUB x-ray, ultrasonography and IVU .Allpatients subjected to open stone surgery. The data were analyzed prospectively with outcome measures of gender, stonelocation, clinical presentation and operative procedures.Results: Out of 257 patients 181 (70.42%) were male and 76 (29.56%) female with male to female ratio of 2.3:1.The ageranged from 1 year to 80 with the mean of 25.8 years. The peak incidence of upper urinary tract stones was in 20-30 yearswhile lower urinary tract stones in both sexes were under 10 years (Table 1). Anatomical distribution of stone showed 116(45.16%) renal, 21 (8.17%) ureteric, 108 (42%) bladder and 12 (4.66%) urethral calculi (Table 2). The commonest clinicalpresentation was that of pain in 67.31% of patients associated with haematuria in 26.7% of cases. Clinical urinary tractinfection (UTI) was in 15% and 8.9% of patients had spontaneous stone passage (lithuria). The symptoms of bladder outletobstruction (BOO) including retention of urine were in 7% of cases. Calculus anuria was in 1.9% of cases and 8.1% patientshad asymptomatic stones. Bilithiasis (chole-nephrolithiasis) was in 5% of cases (Table 3). Open stone surgery included 84(32.68%) simple pylolithotomies, 15 (5.83%) extended pylolithotomies, 6 (2.33%) pylolithotomy and pyloplasty, 5 (1.94%)nephrolithotomy, 6 (2.33%) nephrectomies, 21 (8.17%) uretrolithotomy, Cystolithotomy was 113 (43.96%) cystolithotomy, 2(0.77%) urethrolithotomy and meatotomy in 5 (1.94%) of patients.Conclusion: Urolithiasis is increasing problem with high frequency of bladder stones and male predominance in our part ofSindh province. Open surgery is still needed to treat the patients where modern and minimally invasive therapeutic modalitiesare out of reach and non-availability in public sector. Establishment of modern stone clinics in rural setup is the need oftoday’s medical practice.Keywords: Urinary calculi, Clinical profile, Open stone surgery.

Highlights

Urolithiasis is an ancient disease with global distribution and has perplexed human beings and physicians for many centuries
The peak incidence of upper urinary tract stones was in 20-30 years while lower urinary tract stones in both sexes were under 10 years (Table 1)
The commonest clinical presentation was that of pain in 67.31% of patients associated with haematuria in 26.7% of cases

Summary

Introduction

Urolithiasis is an ancient disease with global distribution and has perplexed human beings and physicians for many centuries. The medical evaluation must identify patients at risk for recurrent stone formation, environmental factors that promote stones and systemic disease that contributes to stone formation. New and effective therapeutic methods to treat urolithiasis have been introduced recently, urinary stones continue to occupy an important place in everyday urological practice.[8] Due to lack of research facilities and remoteness prevailing medical problems are virtually unknown outside of the state of Nawabshah.The high percentage of hospital admissions, surgical procedures and serious complications due to urolithiasis stresses the need to research this major health problem in Nawabshah. The purpose of this paper is to study the basic pattern of urinary stone disease, so that problem areas can be identified in context to medical literature and future research planned

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