SOVREMENNAYA PEDIATRIYA.2016.5(77):125-129; doi10.15574/SP.2016.77.125 

The problem of stone formation in children with neuromuscular dysfunction of bladder 

Shevchuk D.

Zhytomyr Regional Children's Hospital, Zhytomyr, Ukraine

Zhytomyr State University named after Ivan Franko, Zhytomyr, Ukraine

National Medical Academy of Postgraduate Education named after PL Shupyk, Kyiv, Ukraine 

Introduction. Urolithiasis in children is an important clinical problem in pediatric urological practice. Note that while growth in the prevalence of urolithiasis in pediatric populations, the frequency of bladder calculus significantly reduced. Acquires particular importance urolithiasis in violation of urodynamics caused by neuro-muscular dysfunction of the bladder (NMDB) (Kroovand R.L., 1997; Rizvi S.A.H. et al., 2002; Ramachandra P. et al., 2014).

The aim of the study. Analyze the causes and consequences of the formation of bladder calculus in childhood, especially in violation of its accumulation and/or evacuation functions, as well as modern methods of complex (including surgical) treatment of its disease.

Materials and methods. Since 2008 on the base of the Zhytomyr Regional Children's Clinical Hospital operated on 17 children urolithiasis. However, 3 (17.6%) children perform endoscopic surgery (in 2 (66.6%) — 2 of deferred time attempts) failed (1 — herniation calculus in scar-modified bladder neck, 1 — ureteral stricture 1 — cystitis). Thus, 14 children generally performed 19 surgeries, including: 3 (15.8%) — open and 16 (84.2%) — endoscopically. So, 3 (17.6%)

children were operated more than 1 times: 1 child 2 times (1 — open + 1 — endoscopy); 1 child 2 times (both endoscopically); 1 child 4 times (1 — open + 3 — endoscopically). The average age of children was 11.95 yrs (4–17 yrs). Distribution by gender: 75% — boys, 25% — girls. Distribution calculus localization (those who underwent surgery, and those in which the conduct surgery failed to): bladder — 3 (13.6%), ureter — 13 (59.1%), kidney+ureter — 4 (18.2%), kidney — 2 (9.1%). The average hospital stay was 9.2 days. Found that in NMDB patients, the prevalence of microorganisms in the genus Proteus bacteriological examination of urine was 4.8% of all selected urine cultures in 2010, a significant increase to 15.4% in 2013 and 14,8% in 2015.

Results and discussion. These clinical cases of different types of surgery other complications NMDB children — stone. Confirmed important role Proteus infection among etiological factors bladder calculus formation in childhood. 

Conclusions. The problem of stone formation is a key issue in patients with bladder dysfunction. An important etiological link Proteaceae stone is urinary tract infection. Tactics of surgical treatment should be aimed exclusively at reducing urinary tract trauma. Minimally invasive treatment of urolithiasis in patients with bladder dysfunction make it possible to minimize damage to the bladder wall, reduce postoperative period.

Key words: urolithiasis, neuro-muscular dysfunction of the bladder, children.

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