Original Article - Clinical Pattern of Urinary Stone Disease in Our Setting

Objectives: To study the basic clinical pattern of urinary stone disease in our setting. Study design: Descriptive study. Setting: Department of surgery of Nawabshah Medical College Nawabshah over a period of 4 years between August 2003 to August 2007. Subjects: A total of 257 urolith patients with different stone burden enrolled in the study. Methodology: Structured and standardized history and clinical investigations collected in all of urolith patients. The diagnosis of stone disease was based on history, physical examination followed by KUB x-ray, ultrasonography and IVU .All patients subjected to open stone surgery. The data were analyzed prospectively with outcome measures of gender, stone location, clinical presentation and operative procedures. Results: Out of 257 patients 181 (70.42%) were male and 76 (29.56%) female with male to female ratio of 2.3:1.The age ranged from 1 year to 80 with the mean of 25.8 years. The peak incidence of upper urinary tract stones was in 20-30 years while lower urinary tract stones in both sexes were under 10 years (Table 1). Anatomical distribution of stone showed 116 (45.16%) renal, 21 (8.17%) ureteric, 108 (42%) bladder and 12 (4.66%) urethral calculi (Table 2). The commonest clinical presentation was that of pain in 67.31% of patients associated with haematuria in 26.7% of cases. Clinical urinary tract infection (UTI) was in 15% and 8.9% of patients had spontaneous stone passage (lithuria). The symptoms of bladder outlet obstruction (BOO) including retention of urine were in 7% of cases. Calculus anuria was in 1.9% of cases and 8.1% patients had asymptomatic stones. Bilithiasis (chole-nephrolithiasis) was in 5% of cases (Table 3). Open stone surgery included 84 (32.68%) simple pylolithotomies, 15 (5.83%) extended pylolithotomies, 6 (2.33%) pylolithotomy and pyloplasty, 5 (1.94%) nephrolithotomy, 6 (2.33%) nephrectomies, 21 (8.17%) uretrolithotomy, Cystolithotomy was 113 (43.96%) cystolithotomy, 2 (0.77%) urethrolithotomy and meatotomy in 5 (1.94%) of patients. Conclusion: Urolithiasis is increasing problem with high frequency of bladder stones and male predominance in our part of Sindh province. Open surgery is still needed to treat the patients where modern and minimally invasive therapeutic modalities are out of reach and non-availability in public sector. Establishment of modern stone clinics in rural setup is the need of today’s medical practice.