Vesical calculi in children in Kuwait

Bladder stones, which have almost disappeared from much of the world, still occur frequently in developing countries. Kuwait has become a very wealthy nation over the past 25 years, having previously been among the poorest, and many of its people are adopting a "western" life style in relation to their dietary habits, sanitation and control of the environmental temperature within their houses and public buildings. Over a 2-year period, 34 children presented with bladder urethral stones. Their ages ranged from 8 months to 11 years and two-thirds of them were under 4 years. There were 31 males and 3 females. Twenty-six of the 34 patients were from nomadic families living in the rural periphery of Kuwait, although such families represent less than 12% of the total population of the country. The aetiology of bladder stones is complex and no single factor accounts for all, but we found evidence that lifestyle, environment, diet and the incidence of gastroenteritis all can play a part in the formation of stones within the urinary tract. In contrast to other published series, we found considerable evidence for the formation of the stones within the kidneys, with later enlargement in the bladder. Also, in contrast to other series, we found that urate, as opposed to oxylate, is the predominant substance that we suggest crystallizes out onto a mucopolysaccharide matrix in highly concentrated urine when rates of excretion of ammonia and calcium are high and the urinary phosphate buffer is low. Such conditions readily occur in malnourished, dehydrated infants with gastroenteritis.