Annals of African Medicine

: 2017  |  Volume : 16  |  Issue : 3  |  Page : 95--96

Sonographic assessment of urolithiasis in university of Abuja teaching hospital, Nigeria

Kasonde Bowa 
 Department of Surgery, School of Medicine, Copperbelt University, Ndola, Zambia

Correspondence Address:
Kasonde Bowa
Department of Surgery, School of Medicine, Copperbelt University, Ndola

How to cite this article:
Bowa K. Sonographic assessment of urolithiasis in university of Abuja teaching hospital, Nigeria.Ann Afr Med 2017;16:95-96

How to cite this URL:
Bowa K. Sonographic assessment of urolithiasis in university of Abuja teaching hospital, Nigeria. Ann Afr Med [serial online] 2017 [cited 2022 Nov 29 ];16:95-96
Available from:

Full Text


The current study examines an interesting and important area in urology practice in Nigeria in particular, but in Africa as a whole. In general, stone disease in Africa has been known to be much lower than in European countries.[1] This is related to dietary and weather pattern. The western diet is understood to have more indigestible additives which are excreted in the urinary system. In Africa, high levels of stone disease have been typically seen in the area called stone belt, which includes much of Egypt.[1],[2] Therefore, while in developed countries the urological subspecialty of stone disease has developed, this has not been so in much of Sub-Saharan Africa. In previous years, the typical patient has been the European patient presenting with small upper tract stones.[2],[3] Therefore, African urology practice in much of Sub-Saharan Africa has focused mostly on prostate disease and urethral disease. Some pediatric urology diseases such as hypospadias may also be added to this list. There has been little investment in the evaluation and closed management of stone disease simply because it has not been previously seen as common. The common location of stone has been in the lower urinary tract. These have resulted as complications of poorly managed prostate or urethral disease. The chemical composition has been of infective stones (triple phosphate) which tend to be radiopaque and are investigated by plain X-ray (KUB). The current study shows a change in this pattern to an increase in prevalence, a change in presentation, and a change in stone evaluation. It is worthy of note that these stones are increasingly, more likely to be metabolic or dietary, radiolucent, and involving the upper tract. This changing pattern of stone disease is likely to influence urology practice in Africa in the coming years.[4],[5]


The prevalence of stone disease in the developed countries of Europe ranges from 1% to 15% in the population. In Africa and Asia, there is recognized stone belt which covers the area of Egypt, the Middle East, and Asia. In these regions, the prevalence of stone disease is high ranging from 5% to 10%. There is a changing pattern of disease and weather in Africa, which may lead to a widening of this stone belt toward the low prevalence countries of Sub-Saharan Africa. Many African countries in Sub-Saharan Africa have had a high economic growth, ranging from 6% to 10% per annum for a number of years. This has resulted in a change in the traditional African diets which were agro-based foods to a more western diet which has processed foods with additives. In addition, the changing climate is causing wide range of temperature shifts, with increase of temperatures during the hot seasons. These factors may increase the predisposition of the population to stone disease. The widespread urbanization is also improving health services and making these diseases more easily recognizable.[5],[6]


Most stone diseases in Sub-Saharan African have tended to be lower tract stones in male patients. This has been due to poor urological services. The low level of urological services in the continent has resulted in a high prevalence of untreated prostate disease and urethral disease. These have led to the development of bladder stones, secondary to stasis and infection. These stones typically present with dysuria, hematuria, and severe suprapubic pain. The chemical composition of these stones is typically triple phosphates stones that are radiopaque. Hence, the baseline investigation has been a routine plain soft-tissue abdominal X-ray (KUB). With the changing pattern of upper tract stones which may be mostly dietary, and may be radiolucent, the role of ultrasound will become increasingly more important as shown in the current study.[6],[7]


While urinary stones have been previously seen as secondary to an underlying pathology of the urological system, the current study shows that we may see a change in etiology of stone disease in Africa. Previous focus on prevention has been in the earlier detection and successful management of urological disease common in Africa, such as prostate disease and urethral disease. This focus may have to shift or be combined with dietary advice, metabolic screening, and water therapy. The perception by many African urologists of the critical need for training in urology being focused on general urology may need to be revisited. Health services in Africa will need to invest more in extracorporeal short wave lithotripsy, percutaneous nephrolithotomy, and other endoscopic stone management techniques.[7],[8]


There is emerging evidence of an increase in the prevalence of stone disease in Africa. This is not very different from the increase in prevalence that had been noted in developing countries over the last few decades. There is also a change in sex distribution, location, presentation, and type of stone disease. These changes relate probably to the increased urbanization and westernization of African populations. The challenge for the health systems in Africa will be to become aware of these changes early and to be prepared to deal with them effectively. Some of the strategies will include health education for prevention, building capacity in training health providers, and providing equipment for the better detection and management of the emerging problem of stone disease.[9]


1López M, Hoppe B. History, epidemiology and regional diversities of urolithiasis. Pediatr Nephrol 2010;25:49-59.
2Beukes GJ, de Bruiyn H, Vermaak WJ. Effect of changes in epidemiological factors on the composition and racial distribution of renal calculi. Br J Urol 1987;60:387-92.
3Angwafo FF 3rd, Daudon M, Wonkam A, Kuwong PM, Kropp KA. Pediatric urolithiasis in Sub-Saharan Africa: A comparative study in two regions of Cameroon. Eur Urol 2000;37:106-11.
4Ansari MS, Gupta NP. Impact of socioeconomic status in etiology and management of urinary stone disease. Urol Int 2003;70:255-61.
5Mbonu O, Attah C, Ikeakor I. Urolithiasis in an African population. Int Urol Nephrol 1984;16:291-6.
6Vermooten V. Occurrence of renal calculi and their possible relation to diet as illustrated in South African Negroes. JAMA 1937;109:857.
7Esho JO. Experience with urinary calculus disease in Nigerians as seen at the Lagos University Teaching Hospital. Niger Med J 1976;6:18-22.
8Rizvi SA, Naqvi SA, Hussain Z, Hashmi A, Hussain M, Zafar MN, et al. Pediatric urolithiasis: Developing nation perspectives. J Urol 2002;168(4 Pt 1):1522-5.
9Bowa K, Labib M. Lower tract urinary calculi as an index of urological services in a developing country. Urology 2006;68 Suppl 1:283.