Vesical calculi in children
Abstract
Vesical calculi occur due to increased urinary concentration & are commonly seen in children belonging to low socio-economic status. They are usually formed of ammonium acid urate, calcium oxalate or calcium phosphate. Vesical calculi constitute about 70% to 85% of paediatric urolithiasis & boys are affected more than girls. Primary vesical calculi occur in sterile urine & are associated with nutritional deficiency whereas Secondary calculi occur due to infection, obstruction or inflammation. Endemic calculi are associated with oxalate-rich diet. They usually present with hematuria, dysuria, frequent urinary tract infection, urinary urgency & bedwetting. The diagnostic modalities of vesical calculi are Urinalysis, urine dipstick test, serum Creatinine level, plain x-ray abdomen &Intravenous Pyelography. Sonogram is effective in identifying both radiolucent & radiopaque stones. Spiral CT scanning is highly sensitive & specific whereas Pelvic MRI orTechnetium-99m MAG-3 renal scanning yields poor resolution & are not recommended in the evaluation of bladder calculi. Treatment for vesical calculi depends on the size, composition & symptoms. The only effective medical treatment is urinary alkalization. Indications for surgery are failure of medical management, recurrent infections, acute urinary retention, suprapubic pain & significant gross hematuria. Open cystolithotomy was done earlier which is being replaced by cystolitholapaxy. With ongoing advances in instrumentation procedures like Transurethral optical litholapaxy are now applicable to children. Minimally invasive surgeries like extracorporeal lithotripsy, percutaneous nephrolithotripsy & urethroscopy have reduced open surgery to only 1- 4% of cases. Early diagnosis & appropriate management are essential for managing vesical calculi in children.
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References
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