Clinical Features and Surgical Outcomes of the Children With Urolithiasis at a Tertiary Care Hospital: First Report From Somalia

Abstract

IntroductionThere are very few studies regarding pediatric urolithiasis (PU) reported from Africa, and to date, no data have been presented from Somalia. This study evaluated the sociodemographic and radiological characteristics, treatment, and outcome data of the PU patients treated at Somalia's only tertiary care center.MethodThe data of all patients diagnosed with urolithiasis during a 6-year period were reviewed. Only pediatric (age <18) urolithiasis patients were included. Demographic parameters, radiological features, stone characteristics, treatment, and outcome data were collected and analyzed.ResultsOverall, 227 (127 male, 100 female) patients were included. The rate of PU was 8.1%. The mean patient age was 12.7 ± 3.2. More than two-thirds of the patients (n = 161, 70.9%) were adolescents. The stones were located in the kidney in 50.7%, the ureter in 33%, and the bladder in 14.5%. Distal ureteral stones (36%) accounted for the majority of ureteral stones, followed by the ureterovesical junction (26.7%) and proximal ureteral (24%) stones. The mean stone size was 16.2 mm. Most (42.3%) stones had a 10–20 mm diameter, while 23.3% were sized between 6 and 10 mm. Renal insufficiency was present in 5.3%. Among 227 patients, 101 (44.5%) underwent minimally invasive procedures including ureterorenoscopic lithotripsy (n = 40, 18%), retrograde intrarenal surgery (n = 30, 13.2%) and percutaneous nephrolithotomy (n = 31, 14%). Open pyelolithotomy was the most common surgery performed (n = 53, 22.3%). Surgical site infection developed following 3.5% of the open surgery cases. The stone-free rate was 91.3%. It was significantly higher in open cases (98%) compared to the cases performed via a minimally invasive approach (83%) (p = 0.02).ConclusionIn Somalia, PU is more common than in many other countries. Open surgery continues to be the primary treatment modality for children with urolithiasis due to the restricted endourology resources. However, minimally invasive approaches have evolved over the last years.

The prevalence of urolithiasis in subjects undergoing computer tomography in selected referral diagnostic centers in Mogadishu, Somalia

“…However, a recently published retrospective study of 3 years from Mogadishu concerning renal colic containing 435 patients found that 63.4% of the cases had urolithiasis ( 26 ). Furthermore, similar authors reported the first pediatric urolithiasis (<18 years) from Somalia, in which they identified 227 children with urolithiasis in the 6-year period ( 27 ). The above studies which were done in a single center in such a short period and other case reports as well as studies assessing the clinical characteristics and outcomes of adult patients with urolithiasis all indicate the high incidence of urinary stone disease in the country, which could elucidate the high urolithiasis prevalence in our current study ( 28 , 29 ).…”

“…On the other hand, patients with hydronephrosis in the present study accounted for more than 60%, and this back pressure to the kidney independently has a tendency to increase the risk of renal damage and acute kidney injury (AKI) ( 29 ). Furthermore, there are several factors to consider when planning stone management such as stone size, conventionally the higher the stone size, the more complications it involves ( 27 , 31 , 32 ). In the present study, we found that 29.1% of the stones were between 10 and 20 mm, while 21% were > 20 mm, necessitating surgical interventions and could potentially increase the risk of complications.…”