Abstract
Vesical calculi occur due to increased urinary concentration & are commonly seen in children belonging to low socio-economic status. They are usually formed of ammonium acid urate, calcium oxalate or calcium phosphate. Vesical calculi constitute about 70% to 85% of paediatric urolithiasis & boys are affected more than girls. Primary vesical calculi occur in sterile urine & are associated with nutritional deficiency whereas Secondary calculi occur due to infection, obstruction or inflammation. Endemic calculi are associated with oxalate-rich diet. They usually present with hematuria, dysuria, frequent urinary tract infection, urinary urgency & bedwetting. The diagnostic modalities of vesical calculi are Urinalysis, urine dipstick test, serum Creatinine level, plain x-ray abdomen &Intravenous Pyelography. Sonogram is effective in identifying both radiolucent & radiopaque stones. Spiral CT scanning is highly sensitive & specific whereas Pelvic MRI orTechnetium-99m MAG-3 renal scanning yields poor resolution & are not recommended in the evaluation of bladder calculi. Treatment for vesical calculi depends on the size, composition & symptoms. The only effective medical treatment is urinary alkalization. Indications for surgery are failure of medical management, recurrent infections, acute urinary retention, suprapubic pain & significant gross hematuria. Open cystolithotomy was done earlier which is being replaced by cystolitholapaxy. With ongoing advances in instrumentation procedures like Transurethral optical litholapaxy are now applicable to children. Minimally invasive surgeries like extracorporeal lithotripsy, percutaneous nephrolithotripsy & urethroscopy have reduced open surgery to only 1- 4% of cases. Early diagnosis & appropriate management are essential for managing vesical calculi in children.
Highlights
Bladder stones form when substances in the urine concentrate & coalesce into hard, solid lumps
Urinary calculi in children are categorized into 3 broad epidemiologic patterns: calculi seen in premature infants of very low birth weight, upper urinary tract calculi seen in children and adolescents & endemic bladder calculi which are seen in healthy children without any predisposing factors [2]
Pediatric bladder stones are commonly seen in children belonging to poor economic status [4] & usually consist of ammonium acid urate with/ without calcium oxalate or calcium phosphate [5]
Summary
Bladder stones form when substances in the urine concentrate & coalesce into hard, solid lumps. Manuscript Received: 4th Aug 2015 Reviewed: 10th Aug 2015 Author Corrected: 20th Aug 2015 Accepted for Publication: 7th Sept 2015 They are formed of calcium in 70% of cases, uric acid in 20%, magnesium ammonium phosphate (struvite) in International Journal of Surgery & Orthopedics. A primary stone develop in sterile urine, usually originate in the kidney & passes into the bladder. They may be associated with nutritional deficiency of vitamin A, magnesium, phosphate & vitamin B6 [11,12]. 2455-5436 Review Article infection, diet low in animal proteins,chronic mucus production, obesity & decreased activity level. In developed countries they occur due to urinary stasis, ecurrent urinary tract infections, foreign bodies or urinary diversion. There is a common link between endemic calculi & high intake of oxalate-rich vegetables (increased crystalluria), high animal protein diet (low dietary citrate) [15] &intake of polished rice, whichis low in phosphorus& thereby leads to high ammonia excretion
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