During this time, the location of the stone is usually monitored with ultrasound.Torsion of the appendix testis (testicular appendages or hydatid of Morgagni).These stones can cause pain by creating an obstruction of the drainage of the urine.
There are many different kinds of urinary tract stones, with calcium, oxalate, uric acid, and phosphate being the most common components (Table 8.1). Supersaturation occurs when crystal precipitation occurs in the urine in the form of nucleation, the basis of urinary stones. ![]() These processes are influenced by the presence of inhibitors and promoters. Citrate, magnesium, pyrophosphate, glycosaminoglycans, nephrocalcin, and Tamm-Horsfall proteins are inhibitors of crystallization and aggregation. This can occur either because there is an abnormally high amount of stone-forming material in the urine, or the urine is too concentrated because of dehydration. ![]() These classifications may influence the decision-making process with regard to treatment options. In children, stone disease is less common than it is in adults. The incidence of stone disease in children is increasing 30. Bladder stones are more common in boys in less developed nations, particularly in the Middle East and Asia 16, 43. Children can present with stones at any age (eg, premature newborn to teenager). This severe, intermittent, refractory pain, often accompanied by nausea and vomiting, is a less common presentation in children. The pain can localize to the upper abdomen, flank, or pelvis and may radiate to the umbilicus or groin. Renal ultrasonography is very effective for identifying stones in the kidney 3, 24, 30, 43. ![]() The most sensitive test for identifying stones in the urinary system is non-contrast helical CT scanning. It is safe and rapid, with 97 sensitivity and 96 specificity 24, 30. Following stone analysis, metabolic evaluation can be modified according to the specific stone type. Nonsteroidal anti-inflammatory drugs (e.g., Ibuprofen) and opioids can be cautiously used to control acute pain (as analgesic). But the use of tamsulosin in the conservative treatment of distal ureteral stones in the pediatric population should be implemented with caution 43. Therefore supportive care in the form of vigorous hydration (oral or intravenous, as needed) and analgesic therapy is a reasonable first step in a child with a small stone in the absence of fever or complete ureteral obstruction 30, 43.
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