Pediatric urolithiasis
Introduction
Introduction to pediatric urolithiasis Urolithiasis is a common disease in urology. It is a frequently-occurring disease. The vast majority of stones from the bladder and kidneys. A small number of stones originating in the urethra are often secondary to urethral stricture or urethral diverticulum. Some records, Chinese medicine called it "Shilin" or "sand dripping". The disease is closely related to the environment, systemic diseases and other diseases of the urinary system. The mechanism of stone formation has not been fully elucidated. basic knowledge The proportion of illness: 0.0015% Susceptible people: children Mode of infection: non-infectious Complications: urinary retention, hydronephrosis
Cause
Pediatric urolithiasis
(1) Causes of the disease
The urinary stone is deposited and aggregated by crystals and colloids contained in the urine. The formation of stones may be comprehensive. The formation of stones in different compositions and different parts is obviously different. Some are related to the external environment, while others are related to the external environment. Intrinsic factors related to children, such as malnutrition, vitamin A deficiency, geographical environment, eating habits, genetic trends, metabolic changes and local changes in the urinary tract are important factors, such as hyperparathyroidism, urinary tract obstruction, infection, foreign body Etc., the relationship with the formation of urinary stones has been completely affirmed, although some kidney stones have clear causes, such as hyperparathyroidism, renal tubular acidosis, sponge kidney, gout, foreign body, long-term bed rest, obstruction and infection, etc., but large The cause of the formation of most calcium-containing stones is still not fully explained.
1. Factors related to stone formation
(1) Changes in urine quality and quantity:
1 The concentration of substances forming stones in the urine is too high: the most common is calcium in the urine, the discharge of oxalic acid or uric acid is increased, the amount of urine is small and the urine is concentrated, which can cause the concentration of all solute in the urine to increase.
2 urine pH changes.
3 In the urine, the reduction of crystal precipitation substances is reduced: such as citric acid, pyrophosphate, acid mucopolysaccharide, magnesium, etc.
4 colonies in the urine, necrotic tissue, pus can become the core of the stone.
(2) Local factors of the urinary system:
1 urinary stasis: such as urinary tract stenosis, obstruction, diverticulum can cause urine deposition, stone material deposition.
2 urinary tract foreign bodies: such as long-term indwelling catheters, non-absorbable sutures, shrapnel, plastic tubes, hair clips, etc., can be used as attachments to stones.
(3) Systemic factors:
1 metabolic abnormalities: hyperparathyroidism, abnormal calcium and phosphorus metabolism, can cause hypercalciuria; increased uric acid excretion during gout; familial hereditary cystine metabolism abnormalities, can cause cystine stones.
2 diet structure: children lack animal protein, prone to bladder stones, animal protein, excessive intake of vitamin D, too little cellulose, easy to induce upper urinary calculi, less drinking water, concentrated urine, crystals are easy to shape.
Prevention
Pediatric urolithiasis prevention
According to the stone composition, patients with oxalate stones should eat less spinach, potatoes, strong tea, etc. Taking vitamin B6 can reduce the excretion of oxalate. Those who have calcium stones should limit the intake of milk, white flour, and chocolate. Those with uric acid stones should not use high-yielding foods (such as animal internal organs), and can take alkaline drugs to keep the urine pH at 7 to 7.5.
Complication
Pediatric urolithic complications Complications, urinary retention, hydronephrosis
Stones often have obstruction and infection, and urinary reflux, urinary retention, hydronephrosis and so on.
Symptom
Pediatric urolithiasis symptoms Common symptoms Bladder irritation urination pain Urinary pain Acute urinary tract left cold sweat appetite urinary frequency Urinary urinary tract pain Low fever
Pediatric urolithiasis is mainly bladder and urethra stones, more common in children under 4 years old, kidney and ureteral stones have no obvious age difference, kidney stones can be single, but multiple is not uncommon, especially in the case of ureteropelvic junction obstruction The bilateral kidney stones account for about 20%.
1. Kidney stones: Hematuria is the main symptom of kidney stones, more than after severe activity, sometimes hematuria is light, can only see most red blood cells under the microscope, waist or groin pain is an important manifestation of kidney stones, not in infants and young children When you complain, you can cry, even vomit, pale face, and cold sweat, some cases with systemic symptoms, such as low fever, loss of appetite, weight loss, growth retardation, etc., urine test can have most white blood cells, that is, urinary tract Symptoms of infection, occasionally kidney stones with acute anuria as the first symptom, which is due to kidney-kidney reflex.
2. Ureteral calculi: Symptoms are basically the same as kidney stones. The main symptoms are dysuria and painful urination. When dysuria and pain are light and heavy, when children are severely painful, they may pull or rub the penis and perineum. There is a phenomenon of urinary interruption, after changing the position, can continue to urinate, children may have chronic urinary retention, urinary drip and urinary excretion is extremely difficult to cause rectal prolapse, because the child pulls the penis to make it often in a semi-erect state, it is often larger than the same age pediatric penis, just Ureteral bladder wall stones can cause frequent urination, urgency, dysuria and other bladder irritation.
3. Bladder stones: Bladder stones are associated with infection, and therefore have pyuria.
4. Urinary calculi: usually single hair, such as incarceration in the anterior urethra, can touch stones in the penis, and common terminal hematuria, often with acute urinary retention, such as taking into account urinary tract stones, abdominal X-ray film can be Detection of calcium-impermeable X-ray stones, cystine and infectious stones may be light-impermeable X-ray, and X-ray stones may pass B-mode ultrasound and intravenous urography or CT positive filling defect Is detected, such as the diagnosis of stones must be a full set of urinary tract function and radiation examination to detect the presence or absence of urinary tract retention, obstruction and infection, about 1/4 of children with urinary calculi have vesicoureteral reflux, as a cause of tracing, The physical and chemical properties of the stones undergoing surgery, endoscopic removal or self-extraction should be examined. Parallel crystal morphology analysis should also pay attention to the factors of metabolic abnormalities.
Examine
Pediatric urolithiasis examination
1. Urine examination: There is microscopic hematuria, and there are white blood cells and pus cells in the infection, and there are crystals. Determination of 24h urinary calcium, uric acid, creatinine, oxalic acid content, to understand the metabolic state, with or without endocrine disorders; should also be done in urine bacterial culture. Children should check the amount of urinary calcium when they have repeated gross hematuria. The normal maximum is 4 mg / (kg · 24h) or the urinary calcium / creatinine ratio is greater than 0.25.
2. Blood test: There may be anemia. When there is infection, the white blood cells are increased. The bilateral water accumulation causes impaired renal function, uremia and increased serum creatinine. Blood calcium, phosphorus, alkaline phosphatase, and drug susceptibility tests should be measured.
Film degree exam:
1. Urinary plain film (KUB): More than 95% of kidney and ureteral stones can be developed on X-ray films. Add lateral radiographs to exclude other calcified shadows in the abdomen such as gallstones, mesenteric lymph node calcification, venous stones, feces, etc. These shadows are located in front of the anterior border of the vertebral body, while the upper urinary tract stones are generally located behind the leading edge of the pusher. . Too small stones or insufficient calcification often cause difficulties in diagnosis.
2. Excretory urography (IVU): can understand the calculi, urinary tract morphology and renal function, with or without local factors causing the formation of stones. X-ray uric acid stones appear as filling defects in the developed kidney.
3. Cystoscopy and retrograde ureteral pyelography: cystoscopy if necessary. Cystoscopy can peek into the stones embedded in the ureteral orifice. Retrograde ureteral pyelolithoscopy is applicable to cases where the diagnosis is still unknown after IVU to understand the location, extent and nature of obstruction.
4. B-mode ultrasonography: The typical sonographic appearance of kidney stones is a strong echogenic group in the kidney, followed by sound and shadow. However, the acoustic image performance may vary depending on the size, composition, and shape of the stone. Can find small stones and negative stones that can not be displayed on the X-ray film, understand the shape of the kidney and the condition of hydronephrosis. For some cases that are not suitable for IVU, such as pregnant women, those who are allergic to contrast agents, those who have no urine or chronic renal failure, can be used as a means of diagnosis and treatment.
5. Ureteroscopy: When the abdominal plain film does not show stones, and the IVU shows a filling defect that cannot be diagnosed, this examination can confirm the diagnosis and can perform stone removal or gravel. 6. CT examination can find stones that are not developed on plain films.
Diagnosis
Diagnosis and diagnosis of urinary calculi in children
The diagnosis of upper urinary calculi is easier, and sometimes it needs to be differentiated from cholecystitis, cholelithiasis, acute appendicitis and ovarian cyst torsion.
