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Endemic Bladder Stone Disease in Children, Pattern And Current Management: Experience From A Centre In Peri-Urban
Naveed Mahar1, Abdul Saboor Soomro2, Sammar Nissa Abbasi3
1Department of Urology, Sindh Institute of Urology &Transplantation, Sukkur Campus, Pakistan. navidmahardowite@gmail.com.
Insights
Pediatric bladder stones remain endemic in rural areas, predominantly affecting young males. Minimally invasive surgeries like transurethral cystolithotripsy offer better outcomes with fewer complications compared to open procedures.
Area of Science:
- Pediatric Urology
- Endemic Diseases
- Surgical Outcomes
Background:
- Bladder calculi in children present a significant health challenge, particularly in resource-limited, peri-urban settings.
- Understanding the demographic patterns and management outcomes of endemic bladder stones is crucial for public health initiatives.
Purpose of the Study:
- To investigate the epidemiological characteristics of endemic bladder calculi in children.
- To evaluate the effectiveness and complications of current surgical management strategies for pediatric bladder stones.
Main Methods:
- A retrospective longitudinal study was conducted on 254 pediatric patients with bladder stones from January 2020 to December 2021.
- Surgical interventions included open cystolithotomy (OC), transurethral cystolithotripsy (TUCL), and percutaneous cystolithotomy (PCCL).
- Data on patient demographics, stone characteristics, operative details, and complications were analyzed.
Main Results:
- The study identified a strong male predominance (10.5:1 ratio) with a mean age of 4.8 years; 91% of patients were from rural areas.
- Transurethral cystolithotripsy (TUCL) was the most common procedure (65.0%), followed by percutaneous cystolithotomy (PCCL) (30.7%).
- Minimally invasive techniques (TUCL, PCCL) demonstrated lower complication rates (4.8%, 12.8%) and high stone clearance (98.1%, 100%) compared to open cystolithotomy (OC) (27.3% complications, 100% clearance).
Conclusions:
- Pediatric bladder calculus remains endemic in socioeconomically disadvantaged rural populations.
- Minimally invasive cystolithotomy methods offer advantages in terms of shorter hospital stays, cost-effectiveness, and reduced complications.
- Timely diagnosis and intervention, coupled with preventive strategies, are essential for improving outcomes in pediatric bladder stone management.
Purpose:
To share our recent experience of the pattern and demography of endemic bladder calculi in children and the outcomes of current management strategies for the removal of bladder calculi in a peri-urban setting.
Material And Methods:
This retrospective longitudinal study was carried out at a dedicated urology centre. All patients with endemic bladder stones from January 2020 to December 2021 managed at our centre were included in this study. After discharge, each patient was followed up for 1 year. Data analysis was carried out with IBM SPSS v23. Mean and standard deviation were calculated for normally distributed continuous variables; for non-normally distributed continuous variables, median and IQR were calculated; frequency and percentage were calculated for categorical variables.
Results:
This study included 254 patients, with a male-to-female ratio of 10.5:1. The mean age of the patients was 4.80 ± 2.86 years. Ninety-one percent of the patients belonged to rural areas. Open cystolithotomy (OC) was performed in 11 (4.3%) patients, transurethral cystolithotripsy (TUCL) in 165 (65.0%), and percutaneous cystolithotomy (PCCL) in 78 (30.7%). The mean operative time was 48.8 ± 4.34 minutes for TUCL, 36.18 ± 7.4 minutes for open cystolithotomy, and 38.6 ± 5.2 minutes for PCCL. The most common stone composition was ammonium urate + calcium phosphate (33.1%). The complication rate was 4.8% in TUCL, 12.8% in PCCL, and 27.3% in open cystolithotomy. Stone clearance was 98.1% for TUCL and 100% for both PCCL and OC.
Conclusion:
Paediatric bladder calculus is still endemic in rural areas of Sindh with poor socioeconomic backgrounds. Timely diagnosis and early intervention with preventive measures can lead to better outcomes and fewer complications. Minimally invasive methods of cystolithotomy have a shorter hospital stay, are more cost-effective, and have fewer complications as compared to open cystolithotomy.
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