The progress of preoperative and intraoperative urinary calculi analysis / 中华泌尿外科杂志

The incidence and recurrence rates of urinary stone diseases have remained high recently, and stone analysis is of great significance for further understanding of the pathophysiological processes of urinary stones and to develop effective prevention strategies and precise treatment. Imaging evaluation is the main method of preoperative stone analysis, and dual-energy CT has shown its potential in identifying common main components of stones. The emergence of photon counting spectral CT is expected to achieve accurate analysis of stone components at the pixel level. The intraoperative stone analysis mainly relies on the automatic recognition of endoscopic images, and using machine learning algorithms can more reliably predict common stone composition. It is of great significance for stone analysis and assessment of metabolic causes by introducing morpho-constitutional classification (MCC)and observing and describing the papillary renal lesions during operation. This article reviews the progress of preoperative and intraoperative stone analysis, in order to improve clinicians' understanding of the importance of stone analysis, and provide a direction for further clinical research.

Influence of socioeconomic disparities, temperature and humidity in kidney stone composition / Influência de disparidades socioeconômicas, temperatura e umidade na composição de cálculos renais

Abstract Introduction: Large variations in demographic, economic and environmental factors might influence the worldwide distribution of urolithiasis, but scarce data are available concerning their associations with stone composition. We aimed to evaluate the frequency and composition of kidney stones and their associations with temperature, humidity, and human development index (HDI). Materials and Methods: A total of 1,158 stones from distinct patients (47±14 years old, male/female 2:1) were included. The mean annual temperature and relative humidity of each town were considered separately. Results: Calcium oxalate monohydrate (COM) was disclosed in 38.8% of patients, calcium oxalate dihydrate (COD) in 22.1%, mixed COD/apatite in 9.4%, pure apatite in 1.9%, brushite in 1.8%, struvite in 8.3%, pure uric acid in 11.1%, mixed uric acid/COM in 5.6%, and cystine/rare types in 0.8%. Mean HDI of all pooled cities was 0.780±0.03. However, people living in HDI<0.800 regions had twice the odds of having a struvite stone versus those living in HDI>0.800 (OR=2.14, 95% CI 1.11-4.11). Furthermore, a progressive increase in the struvite stones frequency from 4.5 to 22.8% was detected from HDI>0.800 through HDI<0.700. No significant difference for other stone types was disclosed. Separate logistic regression models assessed the association of each stone composition with gender, temperature, humidity and HDI as covariates. Conclusion: Patients living in low HDI areas are more prone to develop struvite stones, possibly due to lower access to healthcare. Temperature and humidity did not represent a specific risk factor for any stone type in the present sample.

Resumo Introdução: Grandes variações em fatores demográficos, econômicos e ambientais podem influenciar a distribuição mundial da urolitíase, mas há muito pouco dado disponível sobre suas associações com a composição do cálculo renal. Nosso objetivo foi avaliar a frequência e composição dos cálculos renais e suas associações com temperatura, umidade e índice de desenvolvimento humano (IDH). Materiais e Métodos: Foram incluídos 1.158 cálculos de pacientes distintos (47 ± 14 anos, masculino / feminino 2:1). A temperatura média anual e a umidade relativa de cada cidade foram consideradas separadamente. Resultados: O oxalato de cálcio monohidratado (COM) foi detectado em 38,8% dos pacientes; oxalato de cálcio dihidratado (COD) em 22,1%; mistos de COD/apatita em 9,4%; apatita pura em 1,9%; brushita em 1,8%; estruvita em 8,3%, ácido úrico puro em 11,1%; mistos de ácido úrico /COM em 5,6% e cistina/tipos raros em 0,8%. O IDH médio de todas as cidades em conjunto foi de 0,780 ± 0,03. No entanto, indivíduos que vivem em regiões com IDH <0,800 apresentaram duas vezes a razão de chances de ter cálculo de estruvita do que aqueles que vivem em cidades com IDH > 0,800 (OR = 2,14; IC 95% 1,11-4,11). Além disso, um aumento progressivo na frequência de cálculos de estruvita de 4,5 para 22,8% foi detectado em IDH> 0,800 até IDH <0,700. Não foi observada nenhuma diferença significante para outros tipos de cálculos. Modelos separados de regressão logística foram utilizados para avaliar a associação de cada tipo de cálculo com gênero, temperatura, umidade e IDH como covariáveis. Conclusão: Pacientes que vivem em áreas com baixo IDH são mais propensos a desenvolverem cálculos de estruvita, possivelmente devido ao menor acesso à assistência médica. A temperatura e a umidade não representaram um fator de risco específico para qualquer tipo de cálculo na presente amostra.

Chronological Trends in Clinical and Urinary Metabolic Features over 20 Years in Korean Urolithiasis Patients

Urolithiasis is common and is becoming more prevalent worldwide. This study assessed the chronological trends in clinical and urinary metabolic features over 20 years in Korean urolithiasis patients. We performed a retrospective analysis of 4,076 patients treated at our clinic from 1996 to 2015. Urinary metabolic data and stone analysis data were available for 1,421 and 723 patients (34.9% and 17.7%), respectively. Patients were categorized into 4 groups according to the date of initial diagnosis: group 1 (1996–2000, n = 897), group 2 (2001–2005, n = 1,018), group 3 (2006–2010, n = 1,043), and group 4 (2011–2015, n = 1,118). Incidental detection of uric acid renal stones has become more prevalent in the past 10 years, accompanied by an increase in body mass index and age at diagnosis. Similarly, the prevalence of diabetes mellitus and of hypertension increased from one group to the next throughout the study period. Levels of 24-hour urinary excretion of sodium, calcium, uric acid, and oxalate have decreased significantly over the study period. The incidence of urinary metabolic abnormalities also showed an identical tendency. The proportion of stones composed of uric acid increased over the study period. In conclusion, incidental detection of uric acid renal stones has become more prevalent in Korea in the past 20 years. Urinary excretion of lithogenic constituents and the incidence of urinary metabolic abnormalities have decreased significantly over this period.

The change of stone composition and its related risk factors in recurrent urolithiasis / 中华泌尿外科杂志

Objective To investigate the proportion , risk factors and tendency of change of stone composition in recurrent urolithiasis .Methods Eighty-five recurrent urolithiasis patients from 2002 to 2014 were enrolled in this retrospective cohort study .There were 61 male and 24 female patients with a median age of 51 (21-89) years at initial events.Among those patients, 70 had two events, 12 had three events, and 3 had more than 3 events.Compositions of initial and recurrent stones were measured by infrared spectrophotometry.Stone type, recurrence interval and recurrence frequency were studied as potential risk factors for composition change . Chi square test and logistic regression analysis were employed in the statistical analysis.Results Stone composition changed during recurrence in 26 patients ( 30.6%) . Univariate analysis showed the risk ratio of composition change in the patients with recurrence interval of 1-5 years was 0.518 (95%CI, 0.277-0.967, P Conclusions Stone composition changes in about one third patients of recurrent urolithiasis .The mutual conversion between calcium oxalate and infection stones is the most common change .Recurrence interval is an independent risk factor to predict composition change .Repeated stone analysis should be suggested to patients with recurrent interval of less than 1 year or more than 5 years.

Temporal alteration of stone composition and onset age in the upper urinary tract: a cross-sectional study of 1 878 cases / 中华泌尿外科杂志

Objective To investigate if distribution of stone composition and onset age in the upper urinary tract changed during the past 12 years in China.Methods There were 1 878 urolithiasis patients of the upper urinary tract in our hospital from 2003 to 2014 enrolled in present cross-sectional study.There were 1 300 male and 578 female patients with a median onset age of 46 (6-95) years.Stone composition was measured by infrared spectrophotometry.All the patients were divided into 3 groups according to the onset year:Year 2003-2006,Year 2007-2010 and Year 2011-2014.The distributions of stone types were compared among the 3 groups.Age and gender were included as potential confounders.Chi square test,P trend test,Kruskal-Wallis test and logistic regression were employed in the statistical analysis.Results Calcium oxalate was the most common type with a dominant proportion of 78.1％ (1 466/1 878),while uric acid had a small proportion of 4.8％ (91/1 878).The proportions of uric acid in the 3 groups were 2.7％ (12/441),5.1％ (39/758) and 5.9％ (40/679),showing an increasing trend (P ＜0.05).Multivariate analysis showed that year group was independently correlated with the proportion of uric acid,with an OR of 1.385 (95％ CI,1.027-1.867).From 2003 to 2014,the proportion of uric acid calculus increased by 0.42％ (95％ CI,0.25％-0.59％) annually.The median ages of disease onset were 43,46 and 49 years respectively in those three groups,also showing an increasing trend with time (P ＜0.01).Conclusion From 2003 to 2014,the proportion of uric acid and onset age in patients of upper urinary tract calculi were increased in the present cohort.

Effect of α1-microglobulin and β2-microglobulin on calcium oxalate urine stone formation / 中华泌尿外科杂志

ObjectiveTo define the difference of urine analysis result,α1-microglobulin (α1-MG) and β2-microglobulin ( β2-MG) between those patients suffering from calcium oxalate stone,non-calcium oxalate stone and non-urolithiasis controls at the same time period.MethodsData from 100 patients admitted to the Department of Urology,First Affiliated Hospital of Anhui Medical University from July,2010 to September,2010 were reviewed.66 patients (45 men,21 women) suffered from urolithiasis,and 34 patients (22 men,12 women) were non-urolithiasis.Patients' ages in urolithiasis group varied from 13 to 78 years and the male to female ratio was 2.1∶1.0.The patients in non-urolithiasis controlgroup aged from 12 to 80 years and the male to female ratio was 1.8∶1.0.Blood and urine were taken from the patient the next morning after admission.The biochemistry from blood and 24 h urine were measured by automatic biochemistry analyzer.The α 1-MG and β2-MG content were measured by radioimmunoassay.The stone compositions were analyzed by infrared spectroscopy.ResultsThere was difference in the levels of serum creatinine and blood urea nitrogen among three groups ( P ＜ 0.05).In controls,those with calcium oxalate stone had higher level of urinary α1-MG and β2-MG,but there were no differences in the urinary electrolyte levels.Group of non-calcium oxalate stones urinary uric acid levels were higher than calcium oxalate and control groups,the difference was statistically significant.ConclusionsIn the formation of uric acid stones,uric acid increased as independent risk factors.α1-MG,β2-MG may promote the formation of calcium oxalate stones.

Urinary Lithiasis in Children : A Single Center Study

PURPOSE: Urinary lithiasis is uncommon in children, however, it may lead to chronic renal insufficiency and even end stage renal disease. The etiology of stone formation in children is largely unknown; although the most common causes are known to be associated with congenital anomalies of the genito-urinary(G-U) tract, urinary tract infections(UTI), and metabolic diseases. METHODS: A total of 73 children(male:female=42:31, mean age 6.6+/-5.3 years) presented with urinary lithiasis between Sep. 1998 and Jul. 2007 at Seoul National University Children's Hospital. The medical records were reviewed retrospectively. RESULTS: The most common presenting symptoms were gross hematuria(28/73, 38%) and flank or abdominal pain(23/73, 32%). The stones were located in the upper urinary tract in 48 patients(66%), in the bladder in 18(24%), and in both the bladder and upper urinary tract in 2 (3%). Congenital anomalies of the G-U tract with/without UTI were detected in 30 children (41%), hypercalciuria with/without hypercalcemia in 15(20%), and other metabolic diseases in 8(11%). In 17 patients(23%), no underlying cause of stone formation was detected. The majority of stones were infected stones(24/36, 67%), which were followed by calcium stones(8/36, 22%), uric acid stones(3/36, 8%), and cystine stones(1/36, 3%). Thirty-four patients(46%) underwent surgical procedures and/or extracorporeal shockwave lithotripsy for stone removal, and 13(18%) passed stones spontaneously with/without medical management. Stones recurred in 6 patients(8%): 4 with neurogenic bladder augmented by ileocystoplasty, 1 with cystinuria, and 1 with unknown etiology. CONCLUSION: The common causes of urinary lithiasis in children were congenital anomalies of the G-U tract with/without UTI and metabolic disorders including hypercalciuria/hypercalcemia. For the management of stones, minimally invasive procedures should be chosen on the basis of accompanying symptoms and the composition, locations and etiology of stones.

Analysis of chemical composition of urinary stones and evaluation of metabolic disturbance in 284 patients / 中华泌尿外科杂志

Objective To study the relationship between chemical composition of urinary stones and metabolic disturbance. Methods 284 urinary stone patients who had undergone analysis of stone composition were evaluated;of them 191 patients had entire blood biochemistry results and 24-h urine analysis results.The relationship between stone composition and metabolic disturbance was analyzed using ?2 test. Results Calcium oxalate stones were found in 195 cases (68.7%),infection stones in 41 cases ( 14.4%),uric stones in 38 cases (13.4%),phosphate stones in 6 cases (2.1%) and cystine stones in 4 cases (1.4%).Metabolic disturbance was found in 176 (92.1%) of 191 patients with entire blood biochemistry results and 24-h urine analysis results.Among the 176 patients,hypercalciuria occurred in 27 cases (14.1%),hyperuricosuria in 54 cases (28.3%),hyperoxluria in 41 cases (21.5%),hyperphophauria in 55 cases (28.8%),hypocitraturia in 128 cases (67.0%),hypomagnesiuria in 80 cases (41.9%),24-h urine volume

Clinical Observations in 4468 Cases of Patients with Urinary Stones / 대한비뇨기과학회지

4468 cases of patients with urinary stones between 1985 and 1995 have been clinically evaluated. The sex ratio was about 1.8: 1 (M: F). 1359 urinary stones have been analysed by infra-red spectrophotometer, calcium containing stones were the most common (80%), magnesium ammonium phosphate (MAP) and uric acid stone was 13.6% and 9.9%, respectively. Among the 212 patients (7%) with urinary tract infection (UTI), Escherichia coli was the most frequently isolated in 85 patients (40.1%). Patients with staghorn calculi and bladder stone were associated with MAP stone and UTI significantly more than other type of stone (p<0.05 by chi-square test). Hypercalciuria was found 275 patients (16%) in male, 208 patients (23.2%) in female, respectively. Primary hyperparathyroidism was diagnosed in 15 cases (0.3%), patients with hypercalcemia were 15, hypercalciuria in 10. 298 cases of 4468 cases (6.7%) were recurrent stone. There was no correlation with clinical parameters for stone formation but MAP stone in female significantly associated with recurrent stone. The duration of stone recurrence was 37.8+/-29.1 months (average). Pediatric stone was 40 cases, there was no clinical difference compared with adult stone. The management of stone with pregnancy was conservative in major. In treatment of renal stone, ESWL was 78.7%, pyelolithotomy in 5.0%, nephrolithotomy in 0.6% and combination therapy with ESWL and surgery was 3.2%. In ureter stone, ESWL was 55.2%, ureterolithotomy in 10.0%, ureteroscopic removal in 8.7% and combination therapy with ESWL and surgery or ureteroscopic removal was 5.5%. Even though the advance in disintegration of stone and removal technique have radically altered the approach to urinary stones, but it is desirable that stone analysis should be performed in all patients and the metabolic evaluation in patients with multiple stones or recurrent disease.

Analysis of Urinary Calculi in Voided Urine after ESWL / 대한비뇨기과학회지

Accurate analysis of urinary calculi is fundamental for study of the etiology of stone formation and essential for treatment of urinary stone and its prevention. A total of 600 patients underwent treatments with ESWL for urinary tract calculi between May, 1987 and June, 1989. The stone fragments that were passed with 99 patient's urine and 21 stone calculi required surgical removal, were analyzed by infrared spectrometer. The following results were obtained : 1. Mixed calculus (58.3%) in much more than single calculus (41.7% ), The most common type of calculi is calcium oxalate-calcium phosphate (69 cases-57.5% ). The most common type of components is calcium oxalate (105 cases-87.5%). 2. Uric acid stones are found in acid urine, and most of magnesium ammonium phosphate stones are found in alkaline urine. 3. 17 of 120 cases have bacteriuria on culture and most of them are ureasplitting organisms. 4. 21 calculi of failed ESWL were analyzed and the components were calcium oxalate-calcium phosphate in 14, calcium oxalate in 4, magnesium ammonium phosphate in 2, uric acid in 1. 5. The causes of failed ESWL were stone components in 5 cases, impacted stone in 10 cases and poor stone localization in 6 cases.