CHILDHOOD BLADDER STONES-AN ENDEMIC DISEASE OF DEVELOPING COUNTRIES.

BACKGROUND: Bladder calculi are one of the commonest health problems in young children especially in rural and underprivileged areas. METHODS: All children of bladder stones operated at District Headquarter Hospital Mithi from July 2009 to June 2012 were included in this cross-sectional study. Data was collected regarding age, sex, address (rural or urban), body weight, duration of breast feeding, weaning, detailed dietary history regarding milk type, volume, amount of water intake, recurrent diarrhoea, urinary tract infection (UTI), family history, and socioeconomic history. Urine analysis, complete blood count (CBC), renal function, ultra sound abdomen, X-ray kidney, ureter, and bladder (KUB) was done in all patients. All patients had cystolithotomy and were followed up till complete recovery. RESULTS: A total of 113 children (97 males and 16 females) operated at District Headquarter Hospital Mithi Tharparker were included in study. All patients belonged to local desert areas of Tharparker. Age ranged from 18 months to 14 year (mean age 8.6 year). Most frequent symptom was difficulty in micturition in 76 (67.25%) patients, urinary retention in 18 (15.9%) and stone with pyuria and fever in 12 (10.6%) patients. Recurrent episodes of diarrhoea (more than 3 episodes per year) in 73(65%) patients, recurrent UTI in 51 (45.6%), family history of stone disease in 6 (5%) and associated rectal prolapse in 3 (2.6%) patients. On x-ray KUB 111 (98%) patients had single stone in bladder, 2 (2%) had multiple stones and an associated renal and ureteric stone in 5 (4.5%). Mild anaemia (Hb 7-10 gm%) was seen in 35 (39.55%) patients, moderate anaemia (Hb 5-7 gm %) was seen in 21(24%) and severe anaemia (Hb less than 5 gm%) was seen in 14 (16%) patients. All patients had open cystolithotomy for removal of stones under general anaesthesia. CONCLUSION: Bladder stones are public health problem. Majority of affected patients were less than 5 years old. Low protein diet, dehydration, use of goat milk and poor socio-economic conditions were major risk factors identified for development of bladder stones.

Intracorporeal lithotripsy: a viable option for proximal ureteric stones.

OBJECTIVE: To compare the stone clearance of upper with middle and lower ureteric stones by using ureteroscopic pneumatic lithotripsy. METHODS: The study was conducted in the Department of Urology, Liaquat National Hospital, Karachi, from February 2009 to February 2010. A total of 90 patients were selected and divided into three groups of 30, each according to the location of stone in the ureter. All patients underwent ureteroscopic pneumatic lithotripsy with 8.5 Fr Wolf rigid ureteroscope and Wolf 2mm probe used for stone fragmentation. All patients were evaluated with X-ray KUB, ultrasound KUB and IVU. Follow-up studies included X-ray and ultrasound KUB performed on 1st postoperative day, after 1 week and at the end of 2nd week. Presence of stone after last follow-up was considered as failure of the procedure. RESULTS: Total number of patients were 90 and mean age was 27.47 +/- 5.8 years. Male female ratio was 2.1:1. Mean stone size was 11.44 +/- 1.41mm. According to the location of the stones, the success rate of pneumatic lithotripsy for upper, middle, and lower ureteral stones was 86.7%, 93.3%, and 96.7% respectively. Completely fragmented stones cleared spontaneously within two weeks in 83 of 90 cases so the overall stone-free rate was 92.2%. CONCLUSION: Ureteroscopic Pneumatic Lithotripsy is an acceptable form of treatment for upper ureteric calculi in addition to middle and lower ureteric calculi. It is a simple, reliable, effective, rapid and safe procedure.

Metanephric adenoma: a rare benign renal tumour.

Metanephric adenoma is a rare benign renal tumour. We are reporting one histologically proven such case in a 23 year old male from Afghanistan. He presented with severe right flank pain since 3 weeks. Nephrectomy was done and histopathology was consistent with the diagnosis of metanephric adenoma. This novel renal mass has been reported to have benign clinical course despite its symptomatic presentation and large tumour size. There is no distinguishing radiological feature with can differentiate it from malignant tumours. So far, a uniformly benign clinical course has been associated with Metanephric adenoma, but given its relatively recent identification and rarity and the lack of clinical, radiographic, or cytologic means to establish a definite diagnosis, Metanephric adenoma remains primarily a pathologic diagnosis.