Burden of urolithiasis: a systematic review of epidemiological and clinical trends in Somalia

Abstract
Background Urolithiasis has become a global major disease that afects millions of people every year. The data
regarding the disease in sub-Saharan Africa are limited. Our purpose is to evaluate the prevalence, epidemiological,
and clinical data related to urolithiasis in Somalia.
Methods Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines,
systematic review utilized Medical Subject Headings (MeSH) on the following sites; PubMed, Web of Science, EBSCO
host, EMBase, Medline, and Cochrane Libraries, using the keywords “Urolithiasis”, “Urinary stone disease”, “Urinary
stones” “Renal stone” “Nephrolithiasis”, “Kidney stone”, “Ureter stone”, “Uretero-lithiasis”, “Bladder stone”, “Cystolithiasis”,
and“Urethral stone” singly and in combinations terms like “Somalia”, “Somaliland”, “Puntland” and“Mogadishu” to identify relevant published studies. After removing 57 duplicate articles and those with incomplete published results,
141 articles were screened based on their abstracts and titles. Finally, only six studies were eligible to be included
in the fnal systematic review.
Results Of the six articles included, 14,612 patient records were reviewed for urinary stone disease prevalence,
patient demographics, radiological stone characteristics, and urinary stone management. The mean patient age
was 34.6. Males were predominantly afected compared to females with 65.7% and 34.3%, respectively. Adults
(≥18 years old) accounted for 87.9% of the patients while 12.1% being children. Reported urolithiasis prevalence
ranged from 8.1% to 17%. Of the 1,442 nephrolithiasis cases, 180 (14.6%) were staghorn calculi while 72.4% had a single stone and 27.6% had multiple stones. The mean stone size was 14.13 mm (±5.96). The majority of the patients, 389
(36.8%), underwent open lithotomy. Percutaneous nephrolithotomy (PCNL) was performed in 234 (22.1%) of cases,
out of which 126 (11.9%) underwent standard PCNL and 108 (10.2%) super mini PCNL (SMP). Ureteroscopic pneumatic surgery (URS) and retrograde intrarenal surgery (RIRS) were performed in 122 (11.5%) and 199 (18%) cases,
respectively.
Conclusion Somalia reported high urolithiasis prevalence. Urological centers in the capital have started using
the new advanced techniques for stone management, nevertheless, open lithotomy is still predominantly utilized. No
study has detailed patient demographics and stone composition has still not been reported.