Introduction: Urologic pathologies of children are frequent. Urinary apparatus diseases occupy the third position after those of respiratory and digestive tracts in children. Objectives: The objective of this study was to investigate epidemiologic, diagnostic, and therapeutic aspects of urologic pathologies of children in our hospital. Patients and Methods: This work is a descriptive and retrospective study from January 1st 2005 to December, 31st 2012 on children from 0 to 15 years old admitted and treated in Teaching Pediatric Hospital Charles de Gaulle for a urologic pathology. Results: In total, 711 patients had been registered with 7.3 sex-ratio, an average age of 4 years old (0 - 15 years old). Malformative pathologies were represented by the majority (62.7%). They were mainly composed of peritoneovaginal canal pathology, posterior urethra valves (PUV), and Pyeloureteral junction anomaly (PUJA). Urolithiasis, infectious, and tumoural pathologies were second, third and fourth with 19.4%, 7.6% and 5.8% respectively. Surgical treatment was necessary for 83.2% of patients. A total nephrectomy has been realized in 5 cases for PUJA with mute kidney. Some post-operative complications have been observed in 2.6% of operated patients. The global mortality rate was 2.9% with Wilms’ tumor predominance in aetiology (58.8%). Conclusion: Urologic pathologies of children are dominated by urogenital malformations. The decreasing of their lethality is guided by a MU antenatal diagnosis and a personal qualification to improve the diagnosis and the treatment.
Urinary apparatus diseases, among children, are in third position after respiratory ways and digestives pathologies [
This work is a descriptive and retrospective study from January 1st 2005 to December 31st 2012 on children from 0 to 15 years old admitted and treated in surgical paediatric service for a urologic pathology. The catchment area spread on the whole country peopled with 17 millions inhabitants; and the under 15 years represented 48%; our pediatric hospital is the only one.
We have included all patients admitted in emergency context or normal consulting whose medical documentation possessed diagnostic information of uropathy and treatment criteria. The variables collected were pidemiologic (age, sex, type and admission mode) diagnosis (consulting delay, clinical and paraclinical information about uropathy), treatment (treatment method, results).
Was defined as a new born, children from 0 to 28 days of live, infants from 29 days to 30 month of live, pre-scholar from 31 month to 5 years old, small child from 6 years to 10 years old and big child from 11 years to 15 years old.
Data have been captured and analysed with the following software: Word and Excel 2010, Epi info 3.5.3.
On 8 years, 711 patients have been admitted for urologic pathology with a hospitable frequency of 88.8 cases/year. During the same period 9540 patients have been hospitalized in the department of pediatric surgery and 10,777 surgical interventions have been performed. These data, above mentioned, represented 7.4% of all hospitalizations and 5.5% of operations (592 interventions).
Patients were admitted on the direct mode in 361 cases (50.9%) and by reference in 350 cases (49.1%). Normal consultion concerned 61.9% and emergency admission 38.1%.
The average age was 4 years with an interval from 0 to 15 years. The distribution by age bracket showed: 3.3% of new born, 42.3% of infants, 26% of pre-scholar, and 28.3% of big children. It was a question of 88% of boys and 12% of girls, namely a sex-ratio of 7.3. The basic characteristics of these 711 patients was summarized into
The average delay for consultation in paediatric surgical service was about 8.43 months with some extremes of 0 to 144 months.
The distribution of patients depending of nosology entities is given in
・ Malformative uropathies
○ High malformative uropathies
Sex | New born (age) | Infants (age) | Pre-scholar (age) | Big children (age) | |
---|---|---|---|---|---|
Male | Female | ||||
626 | 85 | 24 | 301 | 185 | 201 |
Nosologic entities | Number | Percentage (%) |
---|---|---|
Malformative pathology | 446 | 62.7 |
Urinary lithiasis | 138 | 19.4 |
Tumour pathology | 42 | 5.9 |
Infectious pathology | 54 | 7.6 |
Traumatic pathology | 10 | 1.4 |
Other uropathies: | 3 | |
Priapism | 10 | |
Mucous prolapsus of urethra | 4 | |
Iatrogenous fistula of urethra | 4 | |
Secondary ureterovesical reflux | 3 | |
21 | ||
Total | 711 | 100 |
High uropathies in 30 cases were dominated by pyelo-ureteral junction anomalies and the kidney multi-cystic dysplasia with respectively 16 and 6 cases. The other high uropathies were represented by polycystic kidney (n = 2), the kidney agenesis (n = 2), the kidney ectopia (n = 2), the horseshoe-shaped kidney (n = 1) and the bifid ureter (n = 1).
○ Low malformative uropathies
Low uropathies were essentially formed by posterior urethra’s valves (n = 23) and hypospadias (n = 24). The other diagnoses were the bladder exstrophy (n = 8), the congenital reflux from urethra to bladder (n = 1), and the congenital urethral stenosis (n = 1). Other low malformative uropathies were represented by urachus cyst (n = 4), the peritoneovaginal canal pathology (n = 254), the testicular ectopia (n = 69), the spermatic cord torsion (n = 15), paraphimosis (n = 3), phimosis (n = 2), and varicocele (n = 2).
・ Urolithiasis
Urolithiasis concerned boys principally (89.5%). The age bracket from 5 to 10 years was the more concerned with 39.5%. These lithiasis were happened on pre-existing uropathy in 7 cases (4.3%); it’s PUJA (n = 3), PUV (n = 2), kidney ectopia (n = 1) and bifid ureter (n = 1).
・ Kidney and urinary tract tumours
The tumoural pathology was dominated by Wilms’ tumour with 35 cases (83.3% of tumours). The other tumours diagnosed were bladder tumour and testicular with 9.5% and 7.1% of tumours, respectively.
・ Traumatic pathology
Four (4) cases of kidney contusion, 4 cases of urethral stenosis, 1 case of glans amputation after posthectomia and 1 case of urethral section have been registered.
・ Infectious pathology
Fourty two (42) cases of urinary tractus infection with banal germ have been registered and 2 cases among them were urinary schistosomiasis. Infectious complications like pyonephrosis (n = 4) and kidney abscess (n = 1) have been observed. Other type of infections were acute orchiepipidymitis (n = 3), infected urinoma (n = 1) and scrotal abscess (n = 1).
・ Other uropathy
The other uropathies types were the priapism (n = 10), mucous prolapsed of urethra (n = 4), iatrogenic urethral fistula (n = 4) and the secondary ureterovesical reflux (n = 3).
The majority of patients (592 = 83.2%) have required a surgical act and took 5.5% of all surgical activity in the service during this period. The therapeutic method applied was specific to each type of uropathy. The radical nephro-ureterectomia concerned 5 cases of PUJA on the 16 registered cases. The indication was the radiologic mute kidney.
A medical treatment was applied only in 8.2% and in association with surgery in 91.8% of cases. It concerned administration of antibiotics, anti-inflammatories, analgesics, and chemotherapy drugs.
The average hospital stay was 4.5 days with extremes of 1 and 49 days.
After treatment, the evolution was good except in 15 patients who presented 19 postoperative complications. It was parietal suppuration (n = 6), suture breaking (n = 2), bladder fistula (n = 4) and urethral (n = 3), peritonitis (n = 2), intestinal occlusion (n = 1) and evisceration (n = 1). Patients repartition according to the exit mode is given in
Considering the aetiology, dead patients repartition is specified in
Exit mode | Strength | Percentage |
---|---|---|
Better | 667 | 93.8 |
Against medical advice | 8 | 1 |
Transfered | 15 | 2.1 |
Evacuated | 4 | 0.5 |
Death | 17 | 2.3 |
Total | 711 | 100 |
Aetiologies | Strength | Percentage |
---|---|---|
Wilms’ tumour | 10 | 58.8 |
Posterior urethra valves | 2 | 11.8 |
Bladder exstrophy | 1 | 5.8 |
Strangled inguinal hernia | 1 | 5.8 |
Kidney abscess | 1 | 5.8 |
Bladder tumour | 1 | 5.8 |
Urinary lithiasis | 1 | 5.8 |
Total | 17 | 100 |
In our study, per year 88.8 cases for hospital frequency of uropathy have been found. It represented 7.4% of the whole hospitalisation. This proportion is superior to the reports of Agossou-Voyeme and Dao who respectively found 4.8% and 2.8% in their series [
Considering nosologic entities, the uro-genital malformation was the most frequent pathology in our series with a proportion of 62.7%. This predominance had been observed in developed countries’ literature which is similar to developing countries’ literature [
Among these MU, the PUJA was more frequent in terms of high uropathy. His frequency of 2 cases per year (15 cases in 8 years), which is close to the frequency found by Kahloul et al. [
Among low MU, PUV were the most frequent and the most serious. The increasing of creatininemia (average of 133 umol/L) was present at 45% of patients who had PUV. This kidney’s function deterioration in this MU has been also reported by other African authors: Khemakhem and al. (18/38 or 47.4%) and Dami (33.33%) [
The total nephrectomy has been indicated for a muted kidney in 5 cases on 16 PUJA; it forms a high rate. In PJUA, the waited nephrectomy rate was about 10% for primary nephrectomy and inferior to 1% for secondary nephrectomy in the western series at the end of years 1980 [
This screening will have to concern also PUV in particular because of their seriousness. An early and adequate treatment, in particular the endoscopic resection, will contribute to the reduction of this pathology’s lethality.
Postoperatives complications have been observed in 15 patients with a morbidity rate of 2.1%. It was about parietal suppuration in 6 cases and fistula in 7 cases after bladder lithotomy or after surgery of hypospadias and bladder exstrophy.
The global mortality of uropathies in our series was 2.3%. This high rate is similar to rate found by Agossou-Voyeme et al. (2.8%) [
Urologic pathology of the child is frequent. It is dominated by malformations. The MU are potentially serious because in the major forms like the PUJA and PUV, the principal evolving risk is the deterioration of kidney function.
The decreasing of the infantile morbi-mortality linked to urologic pathology goes through:
・ A screening by a complete clinic exam during medical visit or when they are consulting;
・ Obstetrical echography promotion;
・ A physician continuing education;
・ An increasing in number of specialists in paediatric surgery (uro-paediatricians) and medical paediatricians (nephro-paediatricians).
IssoOuédraogo,Toussaint WendlamitaTapsoba,CyprienZaré,EmileBandré,BernadetteBernadette,Somkieta FrancisOuédraogo,AlbertWandaogo, (2015) Urologic Pathologies of Child at Ouagadougou. Open Journal of Urology,05,172-177. doi: 10.4236/oju.2015.59027