Paper Title
GIANT URINARY BLADDER CALCULUS IN PAEDIATRIC AGE: ANATOMICAL AND MORPHOMETRIC CONSIDERATIONS

Abstract
Abstract - Introduction - Urinary bladder calculi are a common cause of urinary retention in paediatric age group. The common etiologies for development of bladder stone in pediatric age group include Bladder outlet obstruction, Recurrent urinary tract infection, Neurogenicbladder, Metabolic factors etc. Low socioeconomic status is a risk factor.1[Basaklar AC, Kale N. Experience with childhood urolithiasis: report of 196 cases. Br J Urol. 1991; 67:203−5] Urinary bladder calculi are uncommon.Bladder calculi accounted for only 2.9% of Urinary tract calculi in a study of 435 patients conducted in Uttarakhand state of India.2[Kakkar M, Kakkar R. A 13 year hospital based study on the Trend of Urinary Stone Disease in Uttarakhand, India. Nepal J Epidemiol. 2021; 11(1); 949-958] Case report- We present a case, in a five year old boy, with no obvious urinary symptoms.A five year old boy was brought by his parents with symptoms of burning micturition.No such previous episode was evident in the past history. Physical examination was non-contributory. There was no history suggestive of UTI. Lab investigations were within normal range.A KUB radiograph showed a large calculus in the urinary bladder. Open vesicolithotomy and suprapubic tube (SPT) placement with removal of the large stone was performed under GA with adequate antibiotic cover.A stone measuring 4 cm in length, 03 cm in width and 1.5 cm in thickness was removed. Discussion - A significant increase in the frequency of occurrence of urinary stone disease in the world’s population has been reported.Dietary habits and the fluid intake have been thought to be main etiological causes.3[Romero V, Akpinar H, Assimos DG. Kidney stones: a global picture of prevalence, incidence, and associated risk factors. Rev Urol. 2010;12(2-3):e86-96]. As the urinary stone disease is multifactorial in nature, it is practically impossible to pinpoint a definite etiological factor.2[Kakkar M, Kakkar R. A 13 year hospital based study on the Trend of Urinary Stone Disease in Uttarakhand, India. Nepal J Epidemiol. 2021;11(1); 949-958]. Metabolic factors are more common in pediatric urolithiasis than in adult stone disease. In our case there was no obvious anatomical abnormality, malnutrition or obesity. Husein et al proposed a formula to designate a urinary bladder calculus as ‘giant’ when the EBV to EBC ratio above 0.028.EBV = Estimated stone volume. EBC = Estimated bladder capacity.In the case of bladder stone in children, the term giant bladder stone which is based only on the stone burden cannot be applied, considering the capacity of a child's bladder that continues to increase with age. 5Ali Husein, Yacobda Sigumonrong. Pediatric's giant bladder stone: A proposed new terminology. International Journal of Surgery Open. 37, 2021, 100409. https://doi.org/10.1016/j.ijso.2021.100409 Conclusion - Familial predisposition and genetic susceptibility have a major role in risk of stone disease in paediatric patients. All such children need a thorough investigation of anatomy of the urinary tract with morphometric assessment. All such children need a thorough metabolic workup.