[Effects of diuretic therapy on spontaneous expulsion of urinary calculi, urinary pH, and crystalluria in lithiasic patients]. / Effets de la cure de diurèse sur l'expulsabilité spontanée des calculs urinaires, le pH urinaire et la cristallurie des patients lithiasiques.

OBJECTIVE: High urine volume is known to be an effective measure for preventing stone recurrence. However, only few studies have investigated its effects on crystalluria and spontaneous passage of calculi. The aim of the study was to assess the effects of high diuresis on stone expulsion and recurrence. PATIENTS AND METHODS: 219 patients were consulting for a first stone episode in Urology units in the Mostaganem area between September 1996 and December 1999. All stones were under 6 mm in size. The patients were divided in two groups: group I included 129 patients (68 males, 61 females) who agreed to be on a high water intake, at least 3 liters per day, over a two months period and to be followed periodically by crystalluria examination in the first morning urine; group II included 90 patients (63 males, 27 females) who declined diuresis advice and urine collection for crystalluria examination. First morning urine collected in patients of group I were examined before (2.95 voidings per subject) and while on diuresis course (2.84 voidings per subject). For each sample, the urine pH was measured and crystals were looked for by polarizing microscopy. Stones spontaneously passed were collected and analyzed by infrared spectroscopy. Group II represented the control group for stone passing and recurrence. RESULTS: Crystalluria was present in 52.4% of urine samples before starting diuresis and decreased at 22.9% of urine samples on high diuresis. Mean pH value increased from 5.73 +/- 0.46 before to 6.09 +/- 0.47 (p < 10-6) while on diuresis course in males and from 5.8 +/- 0.68 to 6.24 +/- 0.66 in females (p < 10-6). The most frequent crystalline species was weddellite. Over the study period, 98 patients (76%) in group I and only 13 patients (14.4%) in group II passed stones spontaneously (p < 10-6 contre group I). No stone recurrence was observed in group I while 37.8% of patients in group II presented at least one stone recurrence (p < 10-7). CONCLUSION: A high diuresis is an effective measure (1) to make easier the passing of stone under 6 mm in size; (2) to reduce the occurrence of crystalluria; (3) to reduce significantly, because of its favourable effect on urine pH, the formation of pH-dependent crystalline phases, thus decreasing heterogeneous nucleation process of calcium oxalate and stone recurrence.

[Correlations between crystalluria and composition of calculi]. / Corrélations entre cristalluries et composition des calculs.

UNLABELLED: The successful fragmentation of kidney stones by means of extracorporeal shock wave lithotripsy partly depends on stone composition. In case of incomplete or coarse fragmentation, multiple urological procedures following ESWL may be necessary for removal of obstructive fragments. It is difficult to be sure that a given stone will be successfully destroyed. X-ray examinations before treatment are useful to classify calculi as calcium stones or not. Nevertheless, such investigations are often not sufficient to identify the main crystalline phases which form the stone and that can make it either resistant or friable to ESWL. OBJECTIVE: The aim of this study was to compare crystalluria and stone composition in patients with kidney calculi. MATERIAL AND METHODS: Seventy-five untreated patients (54 males, 21 females) were included. Their first morning urine was collected three days before surgical removal of the stone. Urine samples were kept at 4 degrees C during 48 hours before examination. RESULTS: Crystalluria occurred in 97.3% of urine specimens. Weddellite was the most frequent crystalline species found in urine (66.2%), followed by carbapatite (33.1%) and whewellite (23.1%). When compared to stone composition, crystalluria was mainly made of weddellite in urines from 68% of patients with weddellite-rich calculi. Stones from patients presenting with whewellite crystals in urine were mainly composed of whewellite in 88.9% of cases. Struvite stones were associated with struvite and carbapatite crystalluria in 85.7% of cases. CONCLUSION: Crystalluria studies could be of clinical interest to predict the main crystalline phase of calcium-containing stones in order to define the best procedures for stone removal.