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[Urinary stones in Tunisian infants, based on a series of 64 cases]
Mohamed Jellouli1, Riadh Jouini, Mongi Mekki
1Unité de recherche 02/UR/08-26: Ethiopathogénie et thérapeutique de la lithiase urinaire du nourrisson au Centre Tunisien.
Insights
Urinary stones in infants are common, with Proteus mirabilis frequently identified. Metabolic abnormalities were infrequent, suggesting a need for thorough etiological surveys in pediatric urolithiasis management.
Area of Science:
- Pediatric Nephrology
- Urology
- Infectious Diseases
Context:
- Urinary stones (urolithiasis) in infants present unique diagnostic and management challenges.
- Understanding the epidemiology and clinical characteristics is crucial for effective treatment strategies in this age group.
- The role of infection and metabolic factors in pediatric urolithiasis requires further investigation.
Purpose:
- To define the epidemiological and clinical characteristics of urinary stones in infants.
- To assess the role of stone chemical analysis in the etiological evaluation of pediatric urolithiasis.
- To outline appropriate treatment modalities for urinary stones in infants.
Summary:
- A study of 64 infants (5-24 months) with urinary stones revealed equal prevalence of upper and lower tract stones.
- Proteus mirabilis was the most common pathogen (48% of cases with positive urine culture).
- Metabolic assessment was abnormal in 9 patients, and 17 out of 37 analyzed stones were pure; surgical treatment was common with no observed complications or recurrence.
Impact:
- The epidemiological profile of infant urinary stones in Tunisia falls between developed and developing countries.
- Low incidence of metabolic abnormalities was noted, potentially due to inadequate etiological surveys.
- Highlights the importance of comprehensive etiological investigations in pediatric urolithiasis, even with a high consanguinity rate.
Objective:
To define the epidemiological and clinical characteristics of urinary stones in infants, to study the role of stone chemical analysis in the aetiological assessment of urinary stones and to define the various treatment modalities adapted to this age-group.
Patients And Methods:
Between 1984 and 2002, 64 infants (age: 5-24 months) were hospitalised for urinary stones. Urine culture was performed in all patients and metabolic assessment was performed in 24 patients. Physicochemical stone analysis was performed by infrared spectrophotometry in 37 patients.
Results:
Upper tract and lower tract stones were equally prevalent. Urine culture was positive in 48 cases. The micro-organism most frequently isolated was Proteus mirabilis (19 cases). The metabolic assessment was normal in 15 patients and pathological in 9 patients. Infrared spectrophotometry showed that 17 stones were pure. 60 patients were treated surgically, 2 were treated by endoscopy associated with intracorporeal lithotripsy. One patient was treated medically and another patient passed the stone spontaneously while in hospital. No intraoperative or postoperative complication was observed. No recurrence was observed in this series. The mean follow-up is 16 months (range: 6 months to 94 months).
Conclusion:
The epidemiological profile of urinary stones in infants in Tunisia is situated between that observed in developed countries and that observed in developing countries. In our study, the incidence of metabolic abnormalities appears to be low despite a high rate of consanguinity in Tunisia. This can be largely explained by the absence of an aetiological survey and/or an inadequate survey when it is performed.
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