Indian 3. Psdlatr.45 : 52, 1078
URETHRAL
CALCULI t
A PAEDIATRIC PROBLEM
OF URINARY LITHIASIg~
S. SlNOH, J.C. DIIALL, SURINDER DALAL, R. YADAV AND G.S. SBKIION
Rohtak Urethral calculus disease is a clinical entity o f urinary lithiasis wi~ich continues to be a paediatric problem in this part of the country. Several authors including T h o m s o n (1921), Noble (1931) and Myers (1957) have published reports on u r i n a r y |ithiasis but the reports on urethral calculi are very few. Malik and Kelasis (1975) arid R e d d y a n d M e e r a b a i (1976) have thrown some light tm this aspect. A m l n (1973) and Paulk a al, (1976) have a t t e m p t ed to provide some guidelines for m a n a g e m e n t of this problem. Retrospective records of the Medical College, Rohtak, m a y be of limited value
Sex. Up to 14 years of age there weft 38 males and no females at~d a b o v e ~ l . years 25 males and 3 females.
in recording the true incidence of urethral calculi because of the n u m b e r of spontaneous expulsions of these stones per urethra, and also because m a n y are dealt with by trained surgeons at district hospitals and p r i m a r y health centres. Thirty-eight such cases were a d m i t t e d to this institution during the period from J a n u a r y , 1973 to J a n u a r y , 1977. T h e patients were mainly from the vicinity o f R o h t a k ( H a r y a n a ) though a few c a m e from neighbouring districts.
Szmplomaloloey is shown in Table'~ Site: This is given in T a b l e 2. Table 1.
SymOtomatology L....--
,
|
9
,
No. o f cases
Perce~l~ ageq~
38
lO0
,
Pain and dysuria Dribbling of urine
3
i3.2
Retention of urine and palpable bladder
25
67.0
Palpable stone
20
53.6
Extravasation of urine
1
2.68
Haematuria
1
2.68
Table 2.
Site of urethral caladi. No.
Observations
of
cases
Age. Ttlere were 9 cases in the age group I-3 years of age, 12 in the 3-5 years age group, 14 in the 6-8 age group a n d 3 in the 9-14 age group. *From the Department of Surgery, Medical College, Rohtak (Haryana). Received on November 4, 1977.
Percentage
i
Posterior
18
47.35
6 8 6
15.8 21.05 [5.8
Anterior Bulbous Penoscrotal Fossa navicularis
|INOH ~.T A L , - - U R E T H R A L CALCULI: A PAEDIATRIG PROBLEM O F URINARY LI'rlIIASI6
Type of treatment,
T a b l e 3.
No, of cases i
i
i
II
Suprapubic cystol'thotomy
i
l
23
ITrp,throlith~176
8
Meatotomy and removal stones
6
No surgery
I
T a b l e 4.
Urinary infection.
Organism
No. of patients
E e,oli
9
pseudoraonas aeruginosa
1
Staph) lococcus aureus
1
Mixed
2
Sterile
5
Discussion In the present study urethral calculi accounted for about 10% of lower urinary tract calculi a d m i t t e d to this hospital. Apart from pain and dysuria acute retention of urine was the commonest result produced by their impaction. More than 60% o f cases were between one to six years o f a g e and all the sufferers were males. These findings are in accordance with the series reported by Amin (1973). T h e rarity of this condition in female children has been explained by Noble (I931) add Campbell (1951), on the basis that the female urethra being short and straight allows smaller stones to pass, which would be held up in boys having a
53
longer and curved urethra. But before we endorse this idea one cannot account for a similar sex difference of urinary lithiasis involving the upper urinary tract. As suggested by Paulk a al. (1976) it sounds reasonable that male sex hormones may be involved in some way in the complex aetiology of urinary calculus formation. Impacted urethral stones were pushed back into the bladder and removed by suprapubic cystostomy on twenty-three patients, urethrolithotomy was the treatment in eight cases. Meatotomy and removal of the stones were performed in six instances where the stones were lodged and impacted at the meatus. One c a s e admitted as an emergency with a palpable stone at the navlcular fossa was relieved automatically i after its spontaneous expulsion. Forward massage of the urethra :n an attempt to milk the stone out was not tried in any of the situations because o f damage to the delicate urethral epithelium leading to strictures On the other hand, the use of urethra! irrigation by saline and paraffin to dislodge stones impacted in the urethra backward into the bladder had been the procedure of choice. The same has been advocated by Amin (1973). (~Ornrn eilt
I t is seen from this study, that the disease in children has distinctive f e a t u r e s (1) All the sufferers were males; (ii) Most o f the sufferers were under 6 years o f age and.(iii) Individual case depending upon its site of impaction should be managed accordingly but gentleness in handling the delicate mucosal urethra is necessary to avoid damage which may lead to serve morbid changes in later stages.
5~
INDIAN .}OURNAL OT PEDIATRICS References Amln, H,A. (1973). Urethral calculi. Br;t, .7. Urol.
451,102. Campbell, M. (1051). Clinical Pediatric Urology. Saundtrt, Philadelphia and London, p. 659. Myers, N.A.A. : Urolithiasis in children (A cllntcal s t u d y o f l l 9 case*), lbid 32 : 49, ]57. Mallk, R.S. and Kelasis, P.P. (1975). Paediatric nephrolithiasis. ]. U, ol. 113 : 545.
VOL. 45, No Noble, T.P. (105I). Vesical oalculus in $ia~alr Brit..7. Urd, 3 : 14. Paulk, 3,C., K~.n, A.U., Malik R..S. and Orej L.F, (1076). Urethral calculi..7. Urol. 116 : t3~. Reddy, M.M., Meerabai, D. (19"/6). Uret~ calculi in children. 3IMA, 66, 172. Thon'aon,J.O. (1021). Urinary calculul at fll Car.:,.:. :1~i'~!, Cz,nton, ba~e.d upon three thouu~, five hundred operation:. Surg. Gynaer and Obstetrkx, 44,
URETHRAL
CALCULI t
A PAEDIATRIC PROBLEM
OF URINARY LITHIASIg~
S. SlNOH, J.C. DIIALL, SURINDER DALAL, R. YADAV AND G.S. SBKIION
Rohtak Urethral calculus disease is a clinical entity o f urinary lithiasis wi~ich continues to be a paediatric problem in this part of the country. Several authors including T h o m s o n (1921), Noble (1931) and Myers (1957) have published reports on u r i n a r y |ithiasis but the reports on urethral calculi are very few. Malik and Kelasis (1975) arid R e d d y a n d M e e r a b a i (1976) have thrown some light tm this aspect. A m l n (1973) and Paulk a al, (1976) have a t t e m p t ed to provide some guidelines for m a n a g e m e n t of this problem. Retrospective records of the Medical College, Rohtak, m a y be of limited value
Sex. Up to 14 years of age there weft 38 males and no females at~d a b o v e ~ l . years 25 males and 3 females.
in recording the true incidence of urethral calculi because of the n u m b e r of spontaneous expulsions of these stones per urethra, and also because m a n y are dealt with by trained surgeons at district hospitals and p r i m a r y health centres. Thirty-eight such cases were a d m i t t e d to this institution during the period from J a n u a r y , 1973 to J a n u a r y , 1977. T h e patients were mainly from the vicinity o f R o h t a k ( H a r y a n a ) though a few c a m e from neighbouring districts.
Szmplomaloloey is shown in Table'~ Site: This is given in T a b l e 2. Table 1.
SymOtomatology L....--
,
|
9
,
No. o f cases
Perce~l~ ageq~
38
lO0
,
Pain and dysuria Dribbling of urine
3
i3.2
Retention of urine and palpable bladder
25
67.0
Palpable stone
20
53.6
Extravasation of urine
1
2.68
Haematuria
1
2.68
Table 2.
Site of urethral caladi. No.
Observations
of
cases
Age. Ttlere were 9 cases in the age group I-3 years of age, 12 in the 3-5 years age group, 14 in the 6-8 age group a n d 3 in the 9-14 age group. *From the Department of Surgery, Medical College, Rohtak (Haryana). Received on November 4, 1977.
Percentage
i
Posterior
18
47.35
6 8 6
15.8 21.05 [5.8
Anterior Bulbous Penoscrotal Fossa navicularis
|INOH ~.T A L , - - U R E T H R A L CALCULI: A PAEDIATRIG PROBLEM O F URINARY LI'rlIIASI6
Type of treatment,
T a b l e 3.
No, of cases i
i
i
II
Suprapubic cystol'thotomy
i
l
23
ITrp,throlith~176
8
Meatotomy and removal stones
6
No surgery
I
T a b l e 4.
Urinary infection.
Organism
No. of patients
E e,oli
9
pseudoraonas aeruginosa
1
Staph) lococcus aureus
1
Mixed
2
Sterile
5
Discussion In the present study urethral calculi accounted for about 10% of lower urinary tract calculi a d m i t t e d to this hospital. Apart from pain and dysuria acute retention of urine was the commonest result produced by their impaction. More than 60% o f cases were between one to six years o f a g e and all the sufferers were males. These findings are in accordance with the series reported by Amin (1973). T h e rarity of this condition in female children has been explained by Noble (I931) add Campbell (1951), on the basis that the female urethra being short and straight allows smaller stones to pass, which would be held up in boys having a
53
longer and curved urethra. But before we endorse this idea one cannot account for a similar sex difference of urinary lithiasis involving the upper urinary tract. As suggested by Paulk a al. (1976) it sounds reasonable that male sex hormones may be involved in some way in the complex aetiology of urinary calculus formation. Impacted urethral stones were pushed back into the bladder and removed by suprapubic cystostomy on twenty-three patients, urethrolithotomy was the treatment in eight cases. Meatotomy and removal of the stones were performed in six instances where the stones were lodged and impacted at the meatus. One c a s e admitted as an emergency with a palpable stone at the navlcular fossa was relieved automatically i after its spontaneous expulsion. Forward massage of the urethra :n an attempt to milk the stone out was not tried in any of the situations because o f damage to the delicate urethral epithelium leading to strictures On the other hand, the use of urethra! irrigation by saline and paraffin to dislodge stones impacted in the urethra backward into the bladder had been the procedure of choice. The same has been advocated by Amin (1973). (~Ornrn eilt
I t is seen from this study, that the disease in children has distinctive f e a t u r e s (1) All the sufferers were males; (ii) Most o f the sufferers were under 6 years o f age and.(iii) Individual case depending upon its site of impaction should be managed accordingly but gentleness in handling the delicate mucosal urethra is necessary to avoid damage which may lead to serve morbid changes in later stages.
5~
INDIAN .}OURNAL OT PEDIATRICS References Amln, H,A. (1973). Urethral calculi. Br;t, .7. Urol.
451,102. Campbell, M. (1051). Clinical Pediatric Urology. Saundtrt, Philadelphia and London, p. 659. Myers, N.A.A. : Urolithiasis in children (A cllntcal s t u d y o f l l 9 case*), lbid 32 : 49, ]57. Mallk, R.S. and Kelasis, P.P. (1975). Paediatric nephrolithiasis. ]. U, ol. 113 : 545.
VOL. 45, No Noble, T.P. (105I). Vesical oalculus in $ia~alr Brit..7. Urd, 3 : 14. Paulk, 3,C., K~.n, A.U., Malik R..S. and Orej L.F, (1076). Urethral calculi..7. Urol. 116 : t3~. Reddy, M.M., Meerabai, D. (19"/6). Uret~ calculi in children. 3IMA, 66, 172. Thon'aon,J.O. (1021). Urinary calculul at fll Car.:,.:. :1~i'~!, Cz,nton, ba~e.d upon three thouu~, five hundred operation:. Surg. Gynaer and Obstetrkx, 44,
