A young boy of ten years complains of dysuria and increased frequency of micturition during day: Most likely diagnosis:
|B||Carcinoma urinary bladder|
a. Endemic bladder stones form in children in the absence of obstruction, local disease, neurologic lesion, or known primary infection.
b. Children in these areas are dependent on a cereal-based diet that is lacking in animal proteins, especially cow's milk .
c. Cereals commonly used are whole wheat flour, millet, and rice. Less than 25% of the total protein intake is of animal origin.
d. Chronic dehydration, excessive protein or oxalate consumption, high endogenous oxalate production, and deficiencies in vitamins A, B1, and B6 and magnesium have been associated with stone formation.
f. Children younger than 10 years are typically affected, with the peak incidence around 3 years .
g. The cloudy, sandy urine produced by children in endemic areas indicates the early stages of stone formation.
h. Girls are able to pass most of the debris through their short, nontortuous urethra, but boys may retain these potential nidi.
i. Male-to-female ratio of 10:1 in endemic bladder calc.
j. Endemic bladder calculi are usually solitary and rarely recur once removed. A mixed cereal diet with milk supplements reduces the incidence of endemic bladder calculi .