Incidence Of Stone Disease Research Articles

Laser Lithotripsy in Renal Lithiasis - 2023 Update - a Narative Review.

Urolithiasis is a serious health issue that is constantly getting worse around the world. In relation to laser lithotripsy, new techniques and technological advancements have emerged, giving urologists a wide range of choices for treating stone disease. The objective of the present review is to provide an overview of the most current developments and show how effective they are for reducing complications and boosting surgical effectiveness. In October 2023, we performed a comprehensive search of the literature, including relevant articles using the PubMed international database to identify related publications concerning ureteroscopic laser stone lithotripsy in renal lithiasis. Both review and original articles were selected. Searches were limited to studies written in English which involved human and adult subjects. All eligible studies concerning ureteroscopic laser lithotripsy were published in 2022 and 2023. They were conducted in Asia (5/10), the North America (3/10) and Europe (2/10), and totalized 1570 patients with an age range between 18 and 85 years. Regarding the primary efficacy outcome, all studies focused on stone free rates (SFRs), complications and average operative time. The rising frequency and incidence of stone disease has led to ongoing breakthroughs in endourology through technological advancements and ongoing developments. Unlike the relatively well-known Holmium laser, which has several uses in the field of stone lithotripsy, Thulium fiber laser (TFL) is a brand-new technological arrangement.

Association of non-Alcoholic Fatty Liver Disease with Urolithiasis detected on non-Contrast Computed Tomography

Background & Objectives: We aimed to assess whether there is an association between urolithiasis and non-alcoholic fatty liver disease using non-enhanced computed tomography. Methods :This is a case control study done from October to December 2019, a total of 284 non-contrasts CT scans of reviewed. The subjects were assigned in to cases of non-alcoholic fatty liver group defined with lower average Hounsfield unit of liver than that of spleen and control involved non-fatty liver defined as patients whose Hounsfield of liver parenchyma higher than that of spleen. We determined the percentage of urolithiasis (patients having radiopaque stones in the urinary tract including kidneys, ureters or urinary bladder) in both groups and calculated their significance of relation. Results: The non-alcoholic fatty liver group involved 112 cases of which 67 (59.8%) male, 45 (40.2%) female and control of non-fatty liver group involved 172 cases; of which, 89 (51.8%) male, 83 (48.2%) female. The incidence of stone disease was significantly higher in non-alcoholic fatty liver (36.6%) than control group (12.2%) which statistically significant with increasing detection rate of renal stone (OR: 4.1, 95% CI, 2.28-7.54). The correlation was still significant when evaluated among males and females separately. Though the prevalence of stone among males (25.6%) is higher than females (17.2), yet it was not statistically significant. This is also true among males (41.8% stone) and females (28.9% stone) in case subjects. Conclusion: Non-alcoholic fatty liver has an association with significant increase in prevalence of urolithiasis than those without non-alcoholic fatty liver, that is can be considered an independent risk factor variable for renal stone formation.

The genetics of kidney stone disease and nephrocalcinosis.

Kidney stones (also known as urinary stones or nephrolithiasis) are highly prevalent, affecting approximately 10% of adults worldwide, and the incidence of stone disease is increasing. Kidney stone formation results from an imbalance of inhibitors and promoters of crystallization, and calcium-containing calculi account for over 80% of stones. In most patients, the underlying aetiology is thought to be multifactorial, with environmental, dietary, hormonal and genetic components. The advent of high-throughput sequencing techniques has enabled a monogenic cause of kidney stones to be identified in up to 30% of children and 10% of adults who form stones, with ~35 different genes implicated. In addition, genome-wide association studies have implicated a series of genes involved in renal tubular handling of lithogenic substrates and of inhibitors of crystallization in stone disease in the general population. Such findings will likely lead to the identification of additional treatment targets involving underlying enzymatic or protein defects, including but not limited to those that alter urinary biochemistry.

Risk factors for urinary stone

Urolithiasis is one of the most common urologic diseases in Korea. The annual incidence of urolithiasis in Korea has increased over time. Understanding the epidemiology and risk factors for urolithiasis is essential for patient care and prevention. The purpose of this review was to summarize the recent literature regarding the risk factors for urolithiasis. The available Korean-population-based trials were enrolled in this study. The peak incidence age was the fifth to sixth decades in Korea. There has been a persistent male predominance in the prevalence and incidence of stone disease. The gender gap has continuously narrowed over the world. Climate and seasonal variations, such as temperature and humidity, have a profound effect on the development of urolithiasis. Various dietary factors, including calcium, sodium, animal protein, and oxalate, play an important role in the development of urolithiasis. Dehydration is a wellknown risk factor for stone disease. Many metabolic diseases can affect urolithiasis, including obesity, hypertension, diabetes, gout, and metabolic syndrome. The fast-moving super-aged society and global warming can increase stone disease burden in the near future. To prevent and reduce stone diseases, clinicians should understand the risk factors affecting stone formation.

Do Lifestyle Factors Including Smoking, Alcohol, and Exercise Impact Your Risk of Developing Kidney Stone Disease? Outcomes of a Systematic Review.

Introduction: With a rise in the incidence of stone disease, more research is needed to understand the lifestyle factors associated with it. We evaluate available evidence for association of smoking, alcohol, and exercise with kidney stone disease (KSD). Methods: A systematic literature search was conducted in CINAHL, EMBASE, Ovid Medline, Cochrane Library, Scopus, Clinicaltrials.gov, and Google Scholar. Different keywords were "smoking," "cigarette," "alcohol," "spirits," "exercise," "physical activity," "training," "kidney stone," "stone disease," "nephrolithiasis," "urolithiasis," "renal stone," and "urinary stone." The main outcome of interest was the role of smoking, alcohol, and exercise in the development of KSD. Results: A total of 4921 articles were found on searching the databases, of which 14 met the criteria for inclusion in the final review. Studies assessed the following risk factors, physical activity (n = 6), alcohol (n = 6), and smoking (n = 9), and included 17,511 patients. The relationship of physical activity with KSD appears to be equivocal. In addition, only one study demonstrated a decreased risk of nephrolithiasis with alcohol consumption. On the contrary, four studies found a significant association between smoking and renal stone formation. Conclusions: While smoking is one behavioral factor that seems to have some association with KSD, no clear effect of alcohol and physical activity has been demonstrated. To avoid KSD, awareness of the possible detrimental role of smoking should be considered and patients should remain vigilant about the importance of hydration with physical activity. While this represents the most appropriate guidance from the evidence available, at present there remain insufficient data to truly reveal the relationship between these three factors and KSD.

Are upper urinary tract stones more common in more deprived populations?

Purpose: To examine the relationship between deprivation and upper tract calculus formation, and provide a contemporary estimate of the incidence of upper urinary tract stone disease. Methods: A retrospective review of hospital episodes for patients presenting to our institution with upper urinary tract stone disease in a 3-year period between 2010 and 2014. Incidence of stone disease was calculated and stratified according to deprivation, as measured by the index of multiple deprivation (IMD) and its subdomains. Poisson regression was used to model the relationship between deprivation and stone disease. Results: The overall incidence of upper urinary tract stone disease was 115 patients/100,000 person-years (95% confidence interval (CI) 108–122 per 100,000 person-years). There is a link between the IMD (as well as a number of its subdomains) and stone disease. The rate of incident stone disease was 50.6% higher in the most deprived quintile of the IMD when compared to the least deprived ( p < 0.001). Multivariate Poisson regression found that education, skills and training deprivation was the subdomain that predicted stone disease most strongly, with the incidence rate ratio being 1.15 (95% CI 1.053–1.261) for each increase in quintile. Conclusion: This study provides a contemporary measure of the incidence of upper urinary tract stone disease derived from a population in the Midlands of England. It informs our understanding of the link between types of deprivation and stone occurrence. Level of evidence: 2b

Pediatric ureteroscopy in underprivileged preschool patients: Single-center perspective

Background: The incidence of stone disease in the pediatric age group dramatically increased in developing countries like Sudan. Despite, the challenges in the management of ureteral stone in the aforementioned age group, ureteroscopy (URS), lithotripsy using Holmium Laser (HO) has been reported as standard effective and safe. The aim of this study is to assess the outcome of URS lithotripsy using HO in preschool patients younger than 5 years of age. Materials and Methods: The results of treatment in 42 patients, who had undergone intervention for ureter stones at Gezira Hospital for Renal Disease and Surgery-Sudan, were prospectively evaluated. Miniscopes with an HO were used for lithotripsy. Results: The mean patient's age was 2.5 ± 1.2 years (1–4 years). The success rate was 69.9% after an average follow-up of 16 months (range 10–24). The majority 81% ( n = 34) of study cases were presented with ureteric stones, which comprised 52.4% ( n = 22) unilateral and 28.6% ( n = 12) bilateral. The cases of unilateral and bilateral stricture include 6 and 2 cases, respectively. After the procedure, the ureteric stenting (double J) was used in 81% of the cases. The perioperative complication rate was 31.0%, and the most common complication was a failure of cannulation followed by the false passage. The mortality rate was zero. Conclusion: URS is considered safe and effective method for pediatric ureteric stones. The size of ureteroscope has an important role in the outcome and complications.

MP41-07 TRENDS IN UROLOGICAL INTERVENTION FOR RENAL STONE DISEASE IN ENGLAND: EVIDENCE FROM HOSPITAL EPISODES STATISTICS (HES) DATABASE

You have accessJournal of UrologyStone Disease: Medical Therapy1 Apr 2015MP41-07 TRENDS IN UROLOGICAL INTERVENTION FOR RENAL STONE DISEASE IN ENGLAND: EVIDENCE FROM HOSPITAL EPISODES STATISTICS (HES) DATABASE Bhaskar Kumar Somani, Ed Chegdy, and Ghulam Nabi Bhaskar Kumar SomaniBhaskar Kumar Somani More articles by this author , Ed ChegdyEd Chegdy More articles by this author , and Ghulam NabiGhulam Nabi More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1635AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Treatment of urological stone disease has evolved in the last decade with the advent and popularity of minimally invasive percutaneous and endoscopic techniques and miniaturization of scopes. With an increase in the incidence of stone disease and cost associated with it, knowing the trends in urological stone disease and its intervention will help us plan our services, train juniors and in ongoing and new research. METHODS The hospital episodes statistics (HES) database was devised in 1987 and contains all NHS activity (diagnosis and intervention) in England whereby data is collected and coded for all patients via the local hospital information systems and the number of episodes are recorded as finished consultant episodes (FCE). To capture the trends in the incidence of urolithiasis and its intervention by shock wave lithotripsy (SWL), ureteroscopy (URS), percutaneous stone surgery (PCNL) and open surgery we analyzed data for the last 6 years from 2007-2013. While we looked at the overall trend, we compared annual data from 2007-2008 (period-1) to 2012-2013 (period-2). RESULTS Total number of FCE for ‘Urolithiasis' increased by 12.5% from 79,199 (period-1) to 89,035 (period-2). A total of 224,454 renal/ureteric stone related procedures were done in NHS England during this 6-year period and included 376 (0.16%) open stone procedures, 9,625 (4%) PCNL procedures, 76,110 (33%) URS and 132,085 (59%) SWL procedures. During this 6-year period the total number of SWL procedures increased by 15%(from 19,386 in period-1 to 22,477 in period-2) but this rise was mainly due to a 20% rise in the reporting of renal SWL with a 6% fall in ureteric SWL. There was a 64% rise (from 9,551 in period-1 to 15,667 in period-2) in the total number of URS procedures during the two periods, with a 96% rise in kidney URS and a 51% rise in the ureteric URS procedure. Although the overall proportion of emergency ureteroscopy procedure was similar in the 2 time periods (12-13%), there was a 64% rise in the total numbers of elective URS procedures in period-2. While there was a 39% fall in the reporting of open stone surgery, there was a 43% rise in the number of PCNL type procedures. CONCLUSIONS There is a consistent trend for greater intervention for renal stone disease for all minimally invasive stone treatments, especially for ureteroscopy. Although it does reflect an increase in prevalence of stone disease, the real reason for this might reflect a better training, equipment availability and surgical expertise in modern day minimally invasive techniques. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e502 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Bhaskar Kumar Somani More articles by this author Ed Chegdy More articles by this author Ghulam Nabi More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...

Does augmentation cystoplasty with continent reconstruction at a young age increase the risk of complications or secondary surgeries?

Lower urinary tract reconstruction with augmentation cystoplasty (AC) is an effective strategy for achieving urinary continence in children with neurogenic or severely compromised bladder. We compared complications and need for secondary surgeries in children 3-5 years of age undergoing AC with continent reconstruction to those ≥ 6 years old. Medical charts of children undergoing AC with continent urinary diversion between 2003 and 2011 were reviewed. Complications and secondary surgeries were analyzed according to patient age. Patient demographics, etiology of bladder dysfunction, bowel segment used, and concomitant procedures were also assessed. One hundred and eight children underwent AC with continent urinary diversion. Mean age at augmentation was 8.5 years (range 3-20). Twenty-eight children (25.9%) were 3-5 years old and 80 (74.1%) were ≥ 6 years. Mean follow-up was 6.93 years (range 1.6-10 years). Bowel segment used included ileum in 59 (54.6%), sigmoid in 33 (30.6%), cecum in 4 (3.7%) and composite in 12 (11.1%). Major complications included bowel obstruction in 6 (5.6%), bladder perforation in 3 (2.8%) and fistula in 2 (1.9%). There was no difference in major complications based on bowel segment utilized (p = 0.804, OR 0.894) or age (p = 0.946, OR 0.969). Fifty children (46.3%) required no additional surgeries; the remaining 58 underwent 137 procedures post-augmentation. Surgeries included urolithiasis management (58/137, 42.3%), appendicovesicostomy revision including stoma revision or redo for persistent leakage between catheterizations in (34/137, 24.8%), bladder neck procedures (26/137, 19%) and revision of MACE (19/137, 13.9%) [Figure]. Incidence of stones in patients 3-5 years (32.1%) was not significantly different than children ≥ 6 years of age (25%, p = 0.463, OR 0.704). Mean number of secondary surgeries for those 3-5 years was 1.21 ± 1.34, which was not statistically different than those ≥ 6 (1.3 ± 1.82, p = 0.154). Children with myelomeningocele (MMC) were statistically more likely to require secondary surgeries than those with other bladder pathology (p = 0.01). Augmentation enterocystoplasty with cutaneous continent catheterizable channel is performed both to protect the upper urinary tract and afford the patient the option of social continence. Continent lower urinary tract reconstruction has been proven technically feasible and safe in preschool-aged children however, the ideal age for augmentation remains unknown. Urolithiasis accounted for over 40% of additional procedures in our series, with 26.9% of patients requiring one or more surgeries for stone disease. The incidence of stone disease in patients 3-5 years of age at the time of augmentation was comparable to that seen in older children. The overall need for additional post-augment procedures was not influenced by patient age or bowel segment utilized, however children with MMC were significantly more likely to require future surgeries than those with a different underlying etiology of bladder dysfunction. Our study has several limitations that warrant mention. Children with neurogenic bladder represent a heterogeneous population, and their surgical outcomes are inherently influenced by underlying disease processes and severity. Complications and secondary surgeries were assessed; however success rates were not evaluated in the current study. Patient and caregiver adherence with CIC and daily bladder irrigation was not assessed; whether noncompliance affected complication rates (i.e. stone formation) is unknown. Whether performed at a young or older age, families must be adequately counseled regarding the daily management responsibilities and potential risks associated with lower urinary tract reconstruction including bladder augmentation. Augmentation with continent urinary diversion in selected patients 3-5 years of age confers complication and secondary surgery risk equal to that observed in their older counterparts.

Renal stone disease in the border regions of Karnataka, Maharashtra and Goa: Role of diet, urinary pH and body mass index

Introduction: Although surgical treatments remove the offending stone, do little to alter the course of the disease. The incidence of stone disease is on the rise, a thorough understanding of the etiology, epidemiology and pathogenesis of urinary tract stone disease is necessary so as to develop an effective medial prophylactic program. We took up this study to analyze geographical factors, diet, body mass index (BMI) in patients from North West Karnataka, South coastal Maharashtra and Goa. Materials and Methods: Patients with renal stones for surgical management at our hospital formed study group. A detailed history of these patients was recorded. The patient's data in relation to diet, BMI, urinary pH, chemical composition of the stone were collected and analyzed. Results: A total of 250, of these 160 patients were from north western Karnataka, 43 from the state of Goa and 47 were from south coastal Maharashtra. Male: Female ratio was 2.33:1. When compared with patients from North West Karnataka and South coastal Maharashtra the mean BMI of the patients from Goa was significantly high, P P Conclusions: Nonvegetarian diet was most commonly seen amongst patients from Goa (74.4%) and south coastal Maharashtra (65.6%) when compared to patients from North West Karnataka (38.2%). Calcium stones were the most common in all the three regions, though the incidence of uric acid calculi was the highest in patients from Goa (37.3%). The urinary pH was significantly lower in patients from Goa when compared with patients from North West Karnataka and South coastal Maharashtra.

Recent management of urinary stone disease in a pediatric population.

The incidence of stone disease has been increasing and the risk of recurrent stone formation is high in a pediatric population. It is crucial to use the most effective method with the primary goal of complete stone removal to prevent recurrence from residual fragments. While extracorporeal shock wave lithotripsy (ESWL) is still considered first line therapy in many clinics for urinary tract stones in children, endoscopic techniques are widely preferred due to miniaturization of instruments and evolution of surgical techniques. The standard procedures to treat urinary stone disease in children are the same as those used in an adult population. These include ESWL, ureterorenoscopy, percutaneous nephrolithotomy (standard PCNL or mini-perc), laparoscopic and open surgery. ESWL is currently the procedure of choice for treating most upper urinary tract calculi in a pediatric population. In recent years, endourological management of pediatric urinary stone disease is preferred in many centers with increasing experience in endourological techniques and decreasing sizes of surgical equipment. The management of pediatric stone disease has evolved with improvements in the technique and a decrease in the size of surgical instruments. Recently, endoscopic methods have been safely and effectively used in children with minor complications. In this review, we aim to summarize the recent management of urolithiasis in children.

Akzidentielle Zerstörung von Steinfangkörben: Neue Erkenntnisse zur Interaktion von Körben, „Stone trapping devices“, Guidewire und Lithotriptoren - eine Kurzübersicht

There is a rise in the incidence of stone disease in the industrial nations. Due to this, the number of endurological procedures will also rise. Sometimes endourological instruments will be fragmented accidentally together with the destruction of the stone. A search for articles on this subject was performed. The aim of this article is to provide a review about the literature on this subject and how this subject can be managed today and in the future.

Prevalence and Composition of Urinary Tract Stones from a Tertiary Care Hospital, Riyadh

Urolithiasis is a common problem in elderly population of developed countries. Urinary stones formation is thought to be multifactorial because of climatic conditions, eating habits, luxurious lifestyle. A monocentric study was carried out to find the rate and chemical composition of calculi in Saudi Population of Riyadh. We studied total 332 urolithiasis patients of King Khalid University Hospital, of age ranging from 1‐90 years (255 M & 77 F). Stone samples were obtained after surgery, for analysis. Fourier transform infrared spectroscopy determines the type and composition of each stone. Urolithiasis was mainly observed in patients aged 51‐60 yrs (24%), especially males belonging 51‐60 yrs (25.8%). Anatomically, stones were found prevalent in kidneys (79.2%). Nephrolithiasis mainly affect females (88.3%). Calcium was the main constituent being seen in 316 (95.1%) stones, of these 178 (53.6%) stones show calcium as only cation with other anions and 138 (41.4%) stones show calcium with magnesium and other anions. Magnesiumcontaining stones were profound in females (57.14%) than males (36.86%). Uric acid (28.1%) and cystine (12.9%) stones were least observed. The current findings demonstrate an increased incidence of stone disease in males, but a shift is noticed in the prevalence by gender in nephrolithiasis in the population. In addition Calcium oxalate stones remain most frequent, with magnesium and uric acid.

Primary prevention of nephrolithiasis is cost‐effective for a national healthcare system

Study Type--Therapy (cost-effectiveness meeting) Level of Evidence 2b. What's known on the subject? and What does the study add? One of the major problems with nephrolithiasis is the high rate of recurrence, which can effect up to 50% of patients over a 5-year period. Patients with recurrent stones are recommended to increase fluid intake based on prospective studies that show a reduction in recurrence rates in patients who intake a high volume of water. Strategies to reduce stones in recurrent stone formers are quite effective with a >50% risk reduction with increased fluid intake alone. Unfortunately, despite a high societal cost and morbidity, there are no prospective studies evaluating the benefit of fluid intake to prevent stone disease in subjects without a prior history of stone but at risk for stones. The budget impact analyses show that prevention of nephrolithiasis can have a significant cost savings for a payer in a healthcare system and reduce the stone burden significantly. Future studies will need to assess the feasibility and effectiveness of such an approach in a population. • To evaluate the impact of primary prevention of stones using a strategy of increased fluid intake. • A Markov model was constructed and analysed using Excel to calculate and compare the costs and outcomes for a virtual cohort of subjects with low vs high water intake. • A literature search was used to formulate assumptions for the model including an annual incidence of urolithiasis of 0.032%, annual risk of stone recurrence of 14.4% and 40% risk reduction in subjects with high water intake. • Costs were based on resource utilisation from the Delphi panel and official price lists in France. • Outcomes were based on payer perspective and included direct and indirect costs and loss of work. • The base-case analysis found total cost of urolithiasis is €4267 with direct costs of €2767, including cost of treatment and complications. The annual budget impact for stone disease based on 65 million inhabitants is €590 million for the payer. • The use of high water intake by 100% of the population results in annual cost savings of €273 million and 9265 fewer stones. Even if only 25% of the population is compliant, there is still a cost saving of €68 million and 2316 stones. • The model was evaluated to determine the impact of varying the assumptions by ±10%. For example, when the incidence of stone disease is increased or decreased by 10% then the mean (range) baseline cost will change by €59(531-649) million for the payer and savings will either increase or decrease by €27 (246-300) million. • The largest impact on cost savings occurs when varying risk reduction of water by 10% resulting in either a mean (range) increase or decrease by €35 (238-308) million. • Varying cost of stone management by 10% has an impact of ±€17 million. Varying other factors such as stone recurrence by 10% has only an impact of ±€9 million and varying risk of chronic kidney disease ±€1 million, as they affect only a portion of the population. • The budget impact analyses show that prevention of nephrolithiasis can have a significant cost savings for a payer in a healthcare system and reduce the stone burden significantly. • Future studies will need to assess the feasibility and effectiveness of such an approach in a population.

HOLMIUM-YAG LASER URETEROSCOPIC LITHOTRIPSY IN A PATIENT WITH ECTOPIC MALROTATED KIDNEY

The incidence of stone disease among patients with congenital renal anomalies including malrotated kidney is more than in normal population due to poor urine drainage and stasis (1). Various minimally invasive options have been used for the management. Ureteroscopy and Holmium:YAG laser lithotripsy have been reported with favorable outcomes (2). We report a 30-year-old male who presented to our hospital having a right side malrotated kidney with a large stone in it. He underwent two session of ureteroscopy and Holmium:YAG laser lithotripsy.

Evolution of stone management in Australia

What's known on the subject? and What does the study add? There is very little contemporary data regarding stone management in Australia. This study assesses the impact of technological advances on stone management practises, and raises questions as to why there is an increasing rate of intervention for stone disease in Australia. Knowledge of management trends as demonstrated in this paper give individual surgeons a guideline for contemporary practise in this country. • To examine trends in the operative management of upper urinary tract stone disease in Australia over the past 15 years. • The Medicare Australia and Australian Institute of Health and Welfare databases were used to determine the annual number of renal colic presentations and procedural interventions undertaken for stone disease. • In Australia over the past 15 years, the annual number of procedural interventions for upper urinary tract stones has increased, primarily due to the rising number of endoscopic procedures performed. • During this period, shock wave lithotripsy numbers have remained steady whilst open and percutaneous procedures have been in decline. • The introduction of and subsequent preference for less invasive techniques has changed the management pathway of patients presenting with stone disease in Australia. • Further studies are necessary to determine whether this escalation in endoscopic procedures is due to an increase in the incidence of stone disease, earlier detection, a lower intervention threshold or a higher retreatment rate.

1055 STONE DISEASE IN CHILDREN LESS THAN FIVE YEARS OF AGE: REAL SYMPTOMS, NOT INCIDENTAL FINDINGS

You have accessJournal of UrologyPediatrics: Stone Disease1 Apr 20101055 STONE DISEASE IN CHILDREN LESS THAN FIVE YEARS OF AGE: REAL SYMPTOMS, NOT INCIDENTAL FINDINGS Travis Groth and Charles Durkee Travis GrothTravis Groth More articles by this author and Charles DurkeeCharles Durkee More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.2167AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Urinary calculi in children under five years of age are rare and are not well understood. The incidence of renal stones in the adult and pediatric population appears to be increasing. The widespread use of CT scanning in theory could diagnose asymptomatic urolithiasis in this patient population and create a factitious increase in the incidence of stone disease. We reviewed this subgroup of our urolithiasis database to better define the presentation and characteristics of children less than 5 years of age with urolithiasis. METHODS We reviewed our experience with 28 patients less than five years of age with upper tract urolithiasis over a 12 year period of time at the Children's Hospital of Wisconsin. Data was collected both concurrently at the time of presentation in to our urolithiasis database and with a retrospective chart review. RESULTS Twenty-eight patients were identified. The average age of presentation was 28 months (range 1-63 months). The most common presenting symptoms were hematuria in 13 (46%) and UTI's in 9 (32%) patients. Pain occurred in 9 patients (32%) but was invariably associated with other symptoms. One patient, age 12 months, presented with renal failure due to bilateral obstructing renal calculi with cystine stones. There were no cases where the finding of stone disease was truly serendipitous. Four (15%) of patients presented with ureteral stones. Notably, 23 of the 28 (82%) patients were males, contrasted to our global database of stone patients less than age 18 years of age where 51% were males. A total of 26 ultraousnds, 23 KUB's and 13 CT scans were performed at initial diagnosis. Fourteen (50%) of the patients had associated urinary tract anomalies which contributed to the development of stone formation. Ten (36%) of the patients had significant medical co-morbidities that may have led to urolithiasis formation. The urinary calculi ranged in size from 2-30mm, the average stone size was 7mm and average ureteral stone size was 6mm. CONCLUSIONS Patients less than 5 years of age with urolithiasis present with active symptoms that should lead to the correct diagnosis with appropriate imaging. In this population, urinary tract anatomic anomalies along with medical co-morbidities contributed significantly to the development of stones. Urolithiasis is not an incidental finding in our group of patients who present in early childhood. Milwaukee, WI© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e410-e411 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Travis Groth More articles by this author Charles Durkee More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Management of stones in childhood

The purpose of this review was to report on the latest world literature relating to paediatric stone disease. Inevitably, because of the small numbers, the literature is limited and consists mainly of case series from individual centres. There is also a wide variation in criteria and techniques, making direct comparison limited. Changes in the incidence of stone disease are becoming more apparent particularly in female patients. Metabolic abnormalities can be identified in the majority of children with stones, and even in the absence of obvious physical stone, if detected warrant further follow-up. Data supporting the safety and efficacy of treatments for stones in children is improving constantly, but choosing the best option may be difficult on current evidence. Better long-term follow-up is still needed regarding adverse effects of treatment. A high index of suspicion is required for the diagnosis of stone disease in children, especially in the very young. After exclusion of anatomical abnormalities, metabolic evaluation is important in management and prevention of recurrence. Modalities for treatment are expanding all the time, but due to overall small numbers, and variations in the availability of technology, consensus views about treatment are difficult to agree.

Female stone disease: the changing trend

This paper has attempted to assess the changes noted in the trends in the incidence and biochemical pattern of female urolithiasis patients during the period 1971-2008. A prospective descriptive clinical study was done on 8,590 stone patients belonging to both sexes treated at the urinary stone clinic. The incidence of stone disease among the two sexes was plotted. The various metabolic parameters including 24-h urine volume, urine calcium, phosphorus, uric acid, oxalate, magnesium, creatinine and citrate, serum creatinine, calcium, phosphorus, uric acid and magnesium and calculated parameter calcium:magnesium ratio were studied. The possible causes for the change in incidence of stone disease in the female sex were elucidated. Of the patients studied, 12.7% (1,091) were females. There was a definite increase in the incidence of female urolithiasis over the past 37 years (P < 0.001). There were significant variations in urine biochemical parameters. There was a definite increase in the excretion of urinary calcium over the years (P < 0.001). The excretion rate of oxalate in urine of females also increased steadily over the years (P < 0.001). The magnesium in urine of females reduced over the years (P < 0.001). Urinary citric acid has however shown an increase over the years (P < 0.001). Urinary excretion of phosphorus (P < 0.001) and urinary uric acid (P < 0.001) showed a decreasing trend. There was a considerable increase in the percentage of females with high calcium:magnesium ratio over the years (P < 0.001). There was a definite decrease in female patients with hypercalcemia over the years. Serum phosphorus and magnesium also increased significantly with the passage of time. Serum uric acid did not vary significantly through the years. The decrease in the excretion rate of magnesium which is inhibitory to stone genesis, together with the increased excretion of calcium and oxalate may have contributed to the increasing incidence of stone disease in females. This might be due to changes in living standards and dietary habits.

Epidemiological trends in urolithiasis: impact on our health care systems

The progressive increase of the social cost for treating urolithiasis could be related to an increased incidence of the disease and/or to an increase of costs for diagnosing and treating renal stones. In the course of the last century, the incidence of renal stones has progressively increased in Europe, North America, and other industrialised countries. This has been explained in terms of changing social conditions and the consequent changes in eating habits. In contrast, renal stones were less frequent than in developing countries of the world but in the last 20 years investigators began to report high incidences of upper urinary stone disease also from some areas of the Third World concurring with the changing of economic and social conditions. Each stone episode involves the costs for emergency visits, diagnostic work up, and medical or surgical treatment. Furthermore, we have to consider the costs of follow-up visits and the costs of testing and drugs for stone prevention. In adjunct of direct costs for diagnosis and treatment, we should also take into account the indirect individual and social cost of workdays lost. Finally, we should estimate the costs of complications and outcomes of treatment with particular attention to the costs of chronic renal failure secondary to stone disease. The strategy of treatment of each stone centre involves different costs for the treatment of each single stone episode. On the other hand the choice of treatment can be driven by National Health Systems and insurance companies by their policy of reimbursement for different procedures. The trends of renal stone incidence will have different impact on health care systems in different countries. In Europe and North America, the peak of incidence has been probably reached but the increase of costs for diagnosing and treating each single stone episode will still increase the social cost for managing stone disease. For this reason the actual objective should be to optimise protocols avoiding redundant or expensive diagnostic procedures or inappropriate treatments. In developing countries, the incidence of stone disease is still increasing and it could reach peaks even higher as a consequence of hot climate in some geographical areas. In those countries the demand for treatment of symptomatic stones could dramatically increase involving a huge financial outlay.