A Rare Reason of Pediatric Urolithiasis: Urethral Stone

Year 2019, Volume: 7 Issue: Ek - IRUPEC 2019 Kongresi Tam Metin Bildirileri, 189 - 190, 10.12.2019

Burcu Daldaban Çiftçi Uğur Özkan , İsmail Dursun

Abstract

Renal stone disease is a significant health problem and can be seen among all ages with an increasing incidence. Pediatric urolithiasis (PU) is prevalent in some geographical regions popularly known as the stone belt1. Many factors are responsible for this endemic nature such as magnesium, phosphates, low protein and high-carbohydrate diet, dehydration, urinary tract infection etc2. The incidence and clinical characteristics of urinary calculi in children vary in relation to geographical location and historical periods that related to climate, genetic, socio-economical factors and dietary factors3-5. The %30-85 of PU cases are related to underlying metabolic abnormalities6.
The major clinic presentation is renal colic in adolescents as adults. However, abdominal pain is the main complaint in school children7. Gross or microscopic hematuria appears in 30% to 55% of all PU. Lower urinary tract symptoms, i.e., dysuria, urinary retention, enuresis, urinary incontinence and pollakiuria, may be associated with distal displacement of calculi. Excessive manipulation of genitalia in preschool children may be an early sign of urethral lithiasis8.
While the location of the stone is mostly in the upper urinary tract in developed countries, bladder stones causing bladder outlet obstruction is seen in developing countries9. Urethral stones are rarely detected compare to other locations10. Herein, we report a child who presented with urinary retention secondary to urethral stone.

Case
4 years old boy was admitted with a complaint of difficulty starting urine stream for 2 months. His medical history was unremarkable trauma, surgical procedure, constipation, encopresis and recurrent urinary tract infection. On admission, His height and weight percentile was in the normal range for his age. Physical examination was normal except supra-pubic tenderness and fullness suggesting a palpable distended bladder. His kidney functions tests were normal. Kidney, ureter and bladder ultrasound showed revealed glob vesicle and a 7.5 mm hyperechoic mass resembling stone in proximal urethra. The proximal urethral stone and glob vesicale were confirmed on CT scan. Because of the location of calculi, stone was pushed into the bladder using cystoscope and broken into smaller fragments, and removed from bladder.

Discussion and conclusion
Acute urinary retention is very common among the pediatric age affected by urethral calculi11. Usually urethral stones are observed in the anterior portion of the urethra and less in the posterior portion12.
Urethral calculi are divided into two types namely primary (when formed within urethra due to some anatomical defect) or secondary (when a stone from upper urinary tract or bladder gets lodged into urethra). These are called migratory stones12. Calcium oxalate stones are commonly reported as most common type of stones in many series13-15. As we see in our case urethra stones may cause obstruction in proximal portion of urethra.
Although the management of the urethra calculi is based the location of stone, initial treatment may be suprapubic urine drainage for urgent relief in some of patients. If the stone located in the posterior portion of urethra or bulbous urethra we can push the calculi into the bladder and use the procedure named endoscopic vesicolithotomy. If the stone is located in penil urethra we can do fossa navicularis meatothomy or first we can try to milking the stone from penil shaft. Another option may be urethrolitothomy in case of failing previous procedures16.

Keywords

Glob vesicale; paediatric; urethral stone

References

• References 1 López M, Hoppe B. History, epidemiology and regional diversities of urolithiasis. Pediatr Nephrol 2010; 25:49-59. 2 Kit LC, Filler G, Pike J, Leonard MP. Paediatric urolithiasis: experience at a tertiary care paediatric hospital. Can Urol Assoc J 2008; 2:381-6. 3 Ali SH, Rifat UN. Etiological and clinical patterns of childhoodurolithiasis in Iraq. Pediatr Nephrol 2005; 20: 1453-1457 [PMID:16010596] 4 Evan AP. Physiopathology and etiology of stone formation in thekidney and the urinary tract. Pediatr Nephrol 2010; 25: 831-841[PMID: 19198886 DOI: 10.1007/s00467-009-1116-y] 5 Sas DJ. An update on the changing epidemiology and metabolicrisk factors in pediatric kidney stone disease. Clin J Am SocNephrol 2011; 6: 2062-2068 [PMID: 21737846 DOI: 10.2215/CJN.11191210] 6 Penido MG, Srivastava T, Alon US. Pediatric primary urolithiasis: 12-year experience at a Midwestern Children’s Hospital. J Urol 2013;189: 1493-1497 [PMID: 23201378 DOI: 10.1016/j.juro.2012.11.107] 7 Cameron MA, Sakhaee K, Moe OW. Nephrolithiasis in children. Pediatr Nephrol 2005; 20: 1587-1592 [PMID: 16133066] 8 Hoppe B, Kemper MJ. Diagnostic examination of the child with urolithiasis or nephrocalcinosis. Pediatr Nephrol 2010; 25: 403-413[PMID: 19104842] 9 Sharma AP, Filler G. Epidemiology of paediatric urolithiasis. Indian J Urol 2010; 26:516-22. 10 Verit A, Savas M, Ciftci H, Unal D, Yeni E, Kaya M. Outcomes of urethral calculi patients in an endemic region and an undiagnosed primary fossa navicularis calculus. Urol Res 2006; 34:37-40. Epub 2006 Jan 24. 11 Yılmaz A, Yürük Yıldırım Z. Çocuklarda üriner sistem taş hastalığına yaklaşım. 2013; 13(4): 154-159 12 Debenham RK. Urethral calculi. Br J Urol 1930; 2:113-21. 13 Jahan Y, Akhtar J, Aziz A. Chemical analysis of urinary calculi in children. J Surg Pak 2000; 5:8-9. 14 Rizvi SA, Sultan S, Zafar MN, Ahmed B, Faiq SM, Hossain KZ, et al. Evaluation of children with urolithiasis. Indian J Urol 2007; 23:420-7. 15 Alaya A, Najjar MF, Nouri A. Changes in stone composition according to age in Tunisian paediatric patients. Int Urol Nephrol2010; 42:621-8. Epub 2009 Nov 24. 16 Akhtar J, Ahmed S, Zamir N. Management of impacted urethral stones in children. J Coll Physicians Surg Pak. 2012 Aug;22(8):510-3. doi: 08.2012/JCPSP.510513.