Urolithiasis in childhood.

During the nineteenth and earlier centuries urolithiasis was a common paediatric problem and the many reports in the literature bear testimony to this. The total incidence of stone in the urinary tract has lessened in this country and at the same time there has been a disproportionate decrease in the number of cases seen in children so that the present incidence in childhood is low. However, urolithiasis must still be regarded as a problem with some paediatric significance, although, apart from relevant sections in special text-books, the recent literature on this subject has been limited to isolated accounts of individual cases. In order to obtain some idea of the present incidence of the disease a review of the clinical material of The Hospital for Sick Children was undertaken. At the present time stone in children not only differs in its incidence from that in the older reports but also in its character. Previously the condition was endemic and there were wellknown 'stone-districts', such as Norfolk. Calculi were then predominantly found in the bladder and they were mostly composed of uric acid or urates. Not only are stones no longer endemic but those stones which do occur tend to be of different site and composition. It is also of interest to note that there does appear to be a difference in the nature of stone as it is seen in different localities. Thus in the nonendemic series reported by Winkel-Smith in 1944 a high percentage of stones was composed of calcium oxalate whereas in Meredith Campbell's cases the majority were composed of uric acid and urates. Stones are still common in many parts of the world and there the triad of endemicity, lower urinary tract calculi and stones composed of uric acid or urates still occurs. During the past 20 years 85 children with urolithiasis were admitted to The Hospital for Sick Children, Great Ormond Street. There was no evidence to suggest that the stones were in any way endemic and they also conformed in other respects to recent reports in that the incidence was considerably higher in the upper than in the lower part of the urinary tract. Analysis of the stones revealed a high proportion of phosphatic calculi so that this series differs from both of those quoted above as well as differing in many respects from earlier reports. The comments which follow are based on the experience of these 85 patients who were all in-patients at some stage during the years 1936 to 1956. During the latter half of this period the total number of admissions to the hospital was 67,127 and during this 10 years 63 of the cases presented. The present relative incidence at The Hospital for Sick Children is thus approximately one case per 1,000 admissions, and, as world affairs considerably modified the figures for admissions during the first half of the period under review, the latter 10 years are more likely to be of present-day significance.