JRSSEM 2021, Vol. 01, No. 5, 486 – 491
E-ISSN: 2807 - 6311, P-ISSN: 2807 - 6494
DOI : 10.36418/jrssem.v1i5.56
PEDIATRIC BLADDER STONE IN SECONDARY HOSPITAL
CARE SETTING: A CASE REPORT
Hafizh Fanani Rizkyansyah 1*
Yudi Y Ambeng 2
1 General Practitioner at Sultan Imanuddin General Hospital
2 Urologist at Doris Sylvanus General Hospital
e-mail: hafiz[email protected] 1 , yudi.ambeng.ya@gmail.com 2
*Correspondence: hafizh.fanani@gmail.com 1
Submitted: 7 December 2021, Revised: 11 December 2021, Accepted: 14 December 2021
Abstract. Bladder Stone is a rare disease accounting for 5% of all urinary calculi. It more common
in middle and low-income countries due to nutritional obstacles, water sanitation, and warm
climates. Prompt diagnosis and management of pediatric bladder stones are essential for
preventing recurrence stones and improving quality of life. It has several surgical approaches. The
objective is reporting a child with a bladder stone that came to secondary hospital setting and the
best management based on it. This report is qualitative observational study. Material came from
direct interview and from medical record. The stone successfully managed with open
cystolithotomy.
Keywords: pediatric; bladder stone.
Hafizh Fanani Rizkyansyah, Yudi Y Ambeng | 487
DOI : 10.36418/jrssem.v1i5.56
INTRODUCTION
Bladder Stone is a rare disease
accounting for 5% of all urinary calculi
(Cicione et al., 2017). It more common in
middle and low-income countries due to
nutritional obstacles, water sanitation, and
warm climates (Mohamed et al., 2021).
Bladder stone in children is common in
West Sumatra, with an incidence of
8.3/100,000 population, and the peak age
of 2–4 years seen in families with a diet low
in protein and phosphates. Many children
suffer from diarrhea (Soliman & Rizvi,
2017).
Bladder stones classify as primary,
secondary, and migratory. Primary or
endemic bladder stone occurs without
other urinary tract pathologies. Secondary
bladder stone involving other urinary tract
abnormalities. A migratory bladder stone is
from the upper tract (Donaldson et al.,
2019). There is different management of
bladder stones between pediatric and
adult. It has several surgical approaches:
Open cystolithotomy, percutaneous
cystolithotomy and transurethral
cytolithotripsy (Rezk-Allah et al., 2019). Our
objective was to report a pediatric bladder
stone case that come to secondary hospital
setting.
MATERIALS AND METHODS
This case report method is qualitative
observational study with retrospective
approach. We got one case as the sample
and population of this study that came to
Doris Sylvanus General Hospital
Palangkaraya, a secondary hospital. The
material collected through direct interview
and medical record then discussed
qualitative with recent literature.
RESULTS AND DISCUSSION
Case Report
We present a pediatric bladder stone
case: A six-year-old Boy came to our
Urology clinic in Doris Sylvanus General
Hospital complaining of lower abdominal
pain and intermittent painful voiding
without hematuria, aggravated by
movement, one month before admission.
Sometimes he experienced micturition
difficulties and pulled his penile on
occasion. There was a history of Colostomy
in his early life due to Hirschsprung disease,
multiple admission to the hospital due to
diarrhea with moderate dehydration, and
circumcised due to phimosis. There was no
family history of stone disease. On physical
examination, there were two surgical scars
in the right lower quadrant. Mass in the
suprapubic region that painful on
palpation. The laboratory investigation
found a slight Anemia (Hb: 9,5g/dl),
Leukocyturia (More than 5 Leucocytes on a
microscopic level), and hematuria (2-5
erythrocytes on a microscopic level). There
were normal blood Urea and creatine
serum level, and other laboratory results
were also. Ultrasonography showed a
bladder stone with 2, 4 x 1, 8cm size. We
performed open cystolithotomy with the
stone completely extracted. The patient has
an indwelling catheter for seven days
without complication noted during those
days after the operation. Three months
follow up after surgery patient was
symptom-free. The best management in
our hospital setting was open
488 | Pediatric Bladder Stone in Secondary Hospital Care Setting: A Case Report
cystolithotomy.
Discussion
A Pediatric bladder stone is a rare
disease. In the last five years, there are few
reports about this condition. (Mohamed et
al., 2021) reported a giant bladder stone
with 152 grams and 7 cm in diameter
(Mohamed et al., 2021). (Palinrungi et al.,
2020) reported a giant bladder stone in a
seven-year-old girl forming around a
sewing needle. (Patodia et al., 2017)
reported bladder stone in a ten-year-old
girl that lead to Acute renal failure. Dharma
et al reported bladder and urethral stone in
12-year-old child (Sharma et al., 2018). We
report bladder stones in a six-year-old boy
with 2,5 cm in diameter.
Endemic bladder calculi form as a result
of two factors that are Dietary and
nutritional deficiency promoting
crystalluria and chronic dehydration related
to diarrheal diseases, high ambient
temperature, and limited water supply, with
the subsequent reduction in urine volume
leading to urinary supersaturation. Most
endemic bladder calculi composed of
ammonium acid urate (AAU) or mixtures of
ammonium acid urate (AAU), CaOX, and
calcium phosphate (CaP) (Soliman & Rizvi,
2017). A previous study identified
metabolic risk factors in 248 (98 %)
patients. Majority of pediatric bladder
stone were less than 5 years old. Low
protein diet, dehydration, use of goat milk
and poor socio-economic conditions were
major risk factors identified for
development of bladder stones (Lal et al.,
2015). The common risk factors were
hypocitraturia in 83 %, hyperoxaluria in
40 %, hyperuricosuria in 33 %, hypocalciuric
in 33 % and low urinary volume in 29 %
(Imran et al., 2017). A detailed metabolic
work of children can identify risk factors in
a majority of the patients. It can help not
only to modify the treatment but also
prevent strategies for recurrence (Imran et
al., 2017). A substitutive feeding in
newborns with high carbohydrate diet can
become the root cause or precipitating
event in initiation of primary bladder stones
(Halstead, 2016).
Bladder stones can classify as primary,
secondary, and migratory (Donaldson et al.,
2019). In our case, besides the hot
temperature in Borneo Island, the patient
also experienced dehydration due to
diarrheal episodes and previous urinary
tract infections that promoted stone
formation. Our case is likely endemic
pediatric bladder stone/primary bladder
stone, though stone and metabolic analysis
are not available in our facility. Curing
metabolic disorder, prevention of
dehydration and treatment of urinary tract
infection can reduce the incidence of
pediatric bladder stones.
The disease is common in male
children, with a male to female ratio of 10:1.
Presenting features include persistent
discomfort or pain in the suprapubic or
hypogastric area, frequency, urgency,
turbid sandy urine, nocturnal enuresis,
dribbling of urine, terminal dysuria,
hematuria, strangury, and possibly
retention of urine as a result of stone
impaction at the bladder neck. The male
children usually grab their penis because of
the radiating pain by the 2, 3 and 4th sacral
nerves. A local examination may reveal a
palpable bladder and rectal prolapse
(Donaldson et al., 2019). The sign and
Hafizh Fanani Rizkyansyah, Yudi Y Ambeng | 489
symptoms in our case are classical findings
in pediatric bladder stones. Laboratory
findings are suggesting slight anemia and
Urinary tract infection present.
Bladder ultrasound is the first test to
detect bladder stones. It is cheap and
highly available. Cystoscopy is the most
accurate to confirm bladder stone
presence. An x-ray may show the presence
of stones in the bladder. However, uric acid
stones may not be visible on x-ray unless
they contain calcium. A CT scan can also
detect stones in the bladder but usually not
used for this purpose because there are
cheaper imaging techniques (Cicione et al.,
2017). We ruled Ultrasonography, which
showed the size of bladder stone
2.5x1.8cm. The volume of the bladder stone
in pediatric population can be estimated
and compare with their respected bladder
volume. (Husein & Sigumonrong, 2021)
propose that the term giant bladder stone
in children should refer to the Estimated
Bladder Volume to Estimated Bladder
Capacity ratio above 0.028.
Perineal lithotomy may be the oldest
elective surgery in children and was the first
operation in a body cavity. With the advent
of antisepsis, a supra-pubic cystotomy
became the operation of choice
(Raffensperger & Raveenthiran, 2019).
Modern management of pediatric bladder
stones is Open cystolithotomy,
Percutaneous Cystolithotomy and
Transurethral Cystolithotripsy (Javanmard
et al., 2018). Endoscopic, transurethral and
percutaneous treatments are associated
with comparable stone-free rates but offer
a shorter operation, a shorter
catheterization duration and a shorter
length of hospital stay compared with open
cystolithotomy in both adults and children.
Shockwave lithotripsy appears to offer a
lower stone-free rate when compared with
other procedures but has the shortest
duration of hospital stay (Donaldson et al.,
2019).
Based on (Yadav et al., 2019) that had
complete clearance of pediatric bladder
stone using the percutaneous approach in
their study. Similar with (Salah et al., 2005).
Percutaneus cystolitotomy is a safe and
effective method for treatment of endemic
bladder stones in children. Open
cystolithotomy is considered the gold
standard with a high stone-free rate
(Javanmard et al., 2018). Due to the Covid
19 Pandemic era and lockdown policy,
every district or Secondary care hospital
should overcome the challenge and give
the best available treatment for the patient.
In our hospital, percutaneous and
transurethral approaches not available.
Open cystolithotomy is the best approach
in secondary hospital setting besides the
size of the stone and the previous history
before. The stone has completely extracted
without complication was noted. Three
months follow up patient is symptom-free.
CONCLUSIONS
The strategy for lowering the incidence
of pediatric bladder stones are curing
metabolic disorders, prevention of
dehydration, and effective treatment of
Urinary tract infection. Prompt diagnosis
and management of pediatric bladder
stones are essential for preventing
recurrence stones and improving quality of
life. The best surgery approach is
depending on the condition of the patient
490 | Pediatric Bladder Stone in Secondary Hospital Care Setting: A Case Report
and the available option, open
cystolithotomy is still the best choice in our
secondary hospital setting.
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© 2021 by the authors. Submitted
for possible open access publication
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Commons Attribution (CC BY SA) license
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