|Year : 2022 | Volume
| Issue : 1 | Page : 44-47
Burden and management of urolithiasis in a newly established urology unit of a tertiary hospital
Muzzammil Abdullahi1, Muhammed Mustapha Kura2, Makama Baje Salihu3
1 Department of Surgery, Bayero University, Kano/Aminu Kano Teaching Hospital, Kano (Visiting Consultant Urologist Federal Medical Centre, Yola, Adamawa State, Nigeria
2 Department of Surgery, Gombe state University/Federal Teaching Hospital, Gombe (Visiting Consultant Urologist Federal Medical Centre, Yola, Adamawa State, Nigeria
3 Department of Surgery, Abubakar Tafawa Balewa University Teaching Hospital, Bauchi (Visiting Consultant Urologist, Federal Medical Centre, Yola, Adamawa State, Nigeria
|Date of Submission||12-Jun-2021|
|Date of Decision||23-Oct-2021|
|Date of Acceptance||09-Nov-2021|
|Date of Web Publication||12-Jul-2022|
Dr. Muzzammil Abdullahi
Department of Surgery, Bayero University, Kano/Aminu, Kano Teaching Hospital, Kano
Source of Support: None, Conflict of Interest: None
Background: Urolithiasis is the third most common affliction of the urinary tract that constitutes a significant burden on the practice of urology. The incidence and prevalence of urolithiasis are increasing globally. Objective: To assess the burden, presentation, and management of urolithiasis in our hospital. Materials and Methods: It was a retrospective descriptive study of patients who were managed for urolithiasis at the urology unit of our hospital between January 2015 and December 2019. Ethical approval was obtained. Patients' bio-data, clinical features, treatment, and complications were extracted from their medical records and entered into the proforma. The generated data were analyzed using SPSS version 21.0. Results: Complete medical records of 68 patients were retrieved. This constituted about 40.6% of urologic patients managed within the period. Their age ranged from 9 to 86 years with the mean age of 43.2 years ± 8.8 standard deviation (SD). The M F was 1.8:1. Students were predominant (29.4%). Others were traders, housewives, civil servants, and farmers. The majority of the patients presented with flank pain (64.7%) and mostly had renal pelvis stone (35.3%). Others had bladder stone (16.2%) and stag horn calculus (11.8%). Nearly all our patients were treated by open surgeries (98.5%) and most (72.1%) did not have any postoperative complication. Conclusion: Urolithiasis constitutes significant workload for urologists in our environment predominantly affecting young and middle-age males. The stones were predominantly in the upper urinary tract with a significant number of stag horn calculi. Despite the non-availability of uroendoscopic facilities, the majority of our patients had good outcome.
Keywords: Burden, management, urolithiasis
|How to cite this article:|
Abdullahi M, Kura MM, Salihu MB. Burden and management of urolithiasis in a newly established urology unit of a tertiary hospital. Niger J Basic Clin Sci 2022;19:44-7
|How to cite this URL:|
Abdullahi M, Kura MM, Salihu MB. Burden and management of urolithiasis in a newly established urology unit of a tertiary hospital. Niger J Basic Clin Sci [serial online] 2022 [cited 2022 Aug 9];19:44-7. Available from: https://www.njbcs.net/text.asp?2022/19/1/44/350713
| Introduction|| |
Urolithiasis has continued to be a common urologic disease affecting a significant percent of the population with increasing burden on urology practice.
The incidence and prevalence of urolithiasis are increasing globally with traditionally higher rates in the Western world., However, similar incidence is seen in developing countries.,
Urolithiasis is attributed to factors such as urinary tract infections (UTIs), poor fluid intake, immobilization or obstructions, and increased excretion of stone-forming particles such as calcium, magnesium, and oxalate.,,
Clinical presentation ranges from being asymptomatic to varying degree and nature of pain, lower urinary tract symptoms, hematuria, and complications such as UTIs and renal impairment.,,,
Diagnosis is best made with non-contrast computerized tomographic scan (CT scan).
Treatment options depend on the site, size, and number of stones, patient's clinical condition, and the availability of facilities for uroendoscopic procedures.,
Urolithiasis being one of the commonest urologic diseases is still being poorly studied in our environment where traditionally is being referred as one of the stone belts of Africa. Urolithiasis is said to be common, mostly among young people. The objective is to undertake a study on such a supposedly common disease in a newly established urology unit to assess the burden and document the epidemiologic characteristics, clinical presentation, and management in our patients that will help provide data for the overall management of urolithiasis.
| Materials and Methods|| |
It was a retrospective descriptive study of all patients who were managed for urolithiasis at the urology unit of our hospital over the period of 4 years (January 2015–December 2019). Prior to commencement of the study, an ethical approval with reference no. FMCY/HREC/20/19 to conduct the study including review of patient's records for the purpose of publication was sought. The institution's research ethics committee after reviewing our submission approved our request, which guaranteed us to conduct the study and subsequently present for publication.
Information on patients treated for urolithiasis in the urology over the period covered by the study was collected from the urology out-patient and theatre register and their medical records were retrieved with the help of the record staff of the hospital. Information about patients' bio-data, presentation, risk factors, investigations done, initial treatment, definitive treatment, and outcome of treatment including complications were extracted from the folders and entered into the already designed proforma.
The above data when collected were intended to be analyzed to assess if urolithiasis is of significant burden among urologic diseases in our environment and document the epidemiologic and clinical characteristics of our patients.
The generated data were entered into Excel sheets and analyzed using special package for social sciences (SPSS version 21.0) and results are presented in tables and figures.
It was a retrospective descriptive study of all patients who were managed for urolithiasis at the urology unit of our hospital over the period of four years (January 2015 to December 2019). Prior to commencement of the study, an ethical approval with Reference no FMCY/HREC/20/19 to conduct the study including review of patient's records for the purpose of publication was sought. The institution's research ethics committee after reviewing our submission approved our request on 21st August 2020 which guaranteed us to conduct the study and subsequently present for publication.
| Results|| |
A total of 89 patients were treated for urolithiasis over the period covered by the study. However, only 68 patients had complete records and were consequently analyzed. The 68 patients constituted about 40.6% of the total urologic patient managed within the study period.
The age distribution of patients is shown in [Figure 1]. The age ranged from 9 to 86 years with a mean age of 43.2 ± 8.8 years.
The majority of the patients were males with M:F = 1.8:1 [Figure 2].
Students were predominant among our patients (29.4%). Others were traders (25%), housewives (22.1%), civil servants (13.2%), and only 10.3% were farmers.
There were no identifiable risk factors in the majority of the patients (76.5%), whereas 14.7%, 5.9%, and 2.9% admitted to having excessive dehydration, family history, and bladder outlet obstruction, respectively.
The majority of the patients presented with flank pain indicating the likelihood of site of the stone and mostly emergency presentation. This is also depicted in [Figure 3].
All patients were evaluated clinically, and the diagnosis was made by abdominopelvic ultrasound, X-ray intravenous urogram, or CT urogram. The diagnostic accuracy of these investigative modalities is shown in [Table 1].
Stones were found in different locations along the urinary tract as shown in [Figure 4] and these were of variable sizes with a range of 0.9 to 8 cm and a mean of 3.2 cm ± 1.2 standard deviation (SD) as shown in [Figure 5].
Various complications were found in our patients that were consequences of the urinary stones, and some factors were found to be associated with these complications as shown in [Table 2].
All patients were treated by open surgeries (98.5%) and medical expulsion therapy (1.5%). This is also shown in [Figure 6].
The majority of the patients (72.1%) did not develop any postoperative complication; however, a few developed complications including UTI/urosepsis (14.7%), surgical site infection (10.3%), and hematuria (2.9%).
| Discussion|| |
Urolithiasis is the third most common affliction of the urinary tract preceded only by UTI and prostatic diseases. In our environment, urolithiasis constitute a significant burden on urology practice considering the significant percentage (40.6%) of all urologic surgeries for urinary stone disease. This is similar to the findings by Seid et al., who in their study reported that it accounted for more than 30% of all their urologic admissions. The age range and mean age of our patients were also similar to those in other studies done in Nigeria.,, Similarly the M:F ratio was also as reported from these studies.,, Skilled work is the predominant occupation among our patients as most were students and civil servants and only a few (10.3%) were peasant farmers. This is similar to the findings of Seid et al. in Ethiopia where the majority of the patients were civil servants and living in the urban area. Flank pain is by far the commonest presentation among our patients indicating the likelihood of the mode of presentation being emergency and the site being ureteric. Earlier studies also reported similar mode of presentation.,,, Non-contrast CT scan has remained the gold standard for the diagnosis for urolithiasis as previously documented in the literature., The stone was diagnosed preoperatively in plain CT films of all patients who had it. The findings of a specific risk factor for urolithiasis will go a long way in adopting preventive measures among people at risk; however, we did not find any risk factor among most of our patients. This might be due to poor disease knowledge of patients when asked about the risk factors. This is similar to findings from other studies. Our environment has a hot climate in most of the year, which is known to predispose to dehydration—a risk factor for urolithiasis—however, only a few of our patients admitted to having excessive dehydration.
The global picture of urolithiasis is such that most of the stones are found in the upper urinary tract with significant percentage of bladder stone in developing countries due to bladder outlet obstruction.,,, There seems to be a shift from this pattern with bladder stone found in small number of our patients. This is probably due to improved knowledge to seek early medical intervention in patients with bladder outlet obstruction. Our finding of stag horn calculus in up to 11.8% of our patients might signify long-standing symptoms in a significant number of our patients and has a high risk for recurrent UTIs and compromised renal function. Complications are common in urolithiasis; UTI is the most common among our patients. particularly those with obstructing stone, renal stone, among others. This is similar to findings in other studies.
Almost all our patients were treated by open surgeries depending on the site of the stone. This is the common practice in developing countries where facilities for endourologic treatment are not readily available.,
Despite the challenge of modern facilities for treatment of urolithiasis complications are rare among our patients. This will build up confidence for patients in seeking early medical care within our available resources.
| Conclusion|| |
Urolithiasis constitute significant workload in the practice of urology in our environment predominantly affecting young and middle-age male adults who are mostly students, traders, and civil servants. No definite risk factor for urolithiasis was found. The stones were predominantly found in the upper urinary tract with a significant percentage of staghorn calculus. The most common associated complications is UTI, particularly more among patients with obstructing and upper tract stone. Despite the non-availability of uroendoscopic facilities for treatment of urolithiasis, the majority of our patients had good outcome.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Ramesh A, Anshuman S, Sachin KJ, Ritika S, Rati S. Renal stones: A clinical review. EMJ Urol 2017;5:98-103.
Omer AR, Yash SK, Roger LS, Khurshid RG, John DD. Burden of urolithiasis: Trends in prevalence, treatments, and costs. Eur Urol Focus 2017;3:18-26.
Charles DS Jr, Gregory ET, Andrew LS, David SG, Robert AS, Ziya K. Urinary stone disease: Advancing knowledge, patient care, and population health. Clin J Am Soc Nephrol 2016;11:1305-12.
Ayun C, Mohamed J, Medina N, Mouhamadou M, Oumar G, Ngor MT, et al
. Surgical management of urolithiasis of the upper tract – current trend of endourology in Africa. Res Rep Urol 2020;12:225-38.
Ijeoma AM, Martin CU, Samuel OE, Ezra OA. Composition of uroliths in a tertiary hospital in South East Nigeria. Afr Health Sci 2018;18:437-45.
Marshal S. Urinary stone disease. In: Tanagho EA, McAninch JW, editors. Smith's General Urology. 17th
ed. New York, USA: The McGraw-Hill Companies; 2008. p. 246-77.
Tilahun A, Beyene P.Kidney Stone Disease: An Update on Current Concepts.Hindawi Advances in Urology 2018;1:1-12.
Seid M, Binyam Y, Alemayehu T, Kirubel A.Urolithiasis: Presentation and Surgical Outcome at a Tertiary Care Hospital in Ethiopia. Research and Reports in Urology 2020;12:623-631. https://www.dovepress.com/ by 188.8.131.52
Sweta B, Archana NS, Tewari D. Urolithiasis: An update on diagnostic modalities and treatment protocols. Indian J Pharm Sci 2017;79:164-74.
Pengbo J, Lillian X, Raphael A, Roshan MP, Jaime L, Ralph VC. Qualitative review of clinical guidelines for medical and surgical management of urolithiasis: Consensus and controversy 2020. J Urol 2021;205:999-1008.
Valentin Z, Patrick B, Dominik A, Hans-Peter S, Cedric MP, Paul MP. Surgical management of urolithiasis – A systematic analysis of available guidelines. BMC Urol 2018;18:1-8.
Olufunmilade O, Muftau B, Omolara W, Olufemi A, Fatai B, Stephen I. A 5-year review of the presentation and management of urolithiasis in a Nigerian teaching hospital. J Surg 2019;7:143-7.
Odoemene CA, Okere PCN, Ugonabo MC. Ureterolithiasis: Management in an environment with limited facilities. Niger J Clin Pract 2017;20:622-8.
] [Full text]
Nada YB, Raghad BA, Fatmah AA, Esraa GA, Abdullah KMD, Basim SA. Urolithiasis: Prevalence, risk factors, and public awareness regarding dietary and lifestyle habits in Jeddah, Saudi Arabia in 2017. Urol Ann 2020;12:56-62.
Li Y, Yan S, Liu J, Liu Y, Zhu X, Gong X. Risk factors for urinary tract infection in patients with urolithiasis—primary report of a single center cohort. BMC Urol 2018;18:45.
Francis KW, Alfred H, Daniel M. Urolithiasis analysis in a multiethnic population at a tertiary hospital in Nairobi, Kenya. BMC Res Notes 2017;10:1-5.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]
[Table 1], [Table 2]