PD21-01 OUTCOMES AND RATES OF DISSOLUTION THERAPY FOR URIC ACID STONES

Abstract

You have accessJournal of UrologyStone Disease: Medical & Dietary Therapy (PD21)1 Sep 2021PD21-01 OUTCOMES AND RATES OF DISSOLUTION THERAPY FOR URIC ACID STONES Jonathan Moore, Amihay Nevo, Saif Salih, Haidar Abdul-Muhsin, Mira Keddis, Karen Stern, and Mitchell Humphreys Jonathan MooreJonathan Moore More articles by this author , Amihay NevoAmihay Nevo More articles by this author , Saif SalihSaif Salih More articles by this author , Haidar Abdul-MuhsinHaidar Abdul-Muhsin More articles by this author , Mira KeddisMira Keddis More articles by this author , Karen SternKaren Stern More articles by this author , and Mitchell HumphreysMitchell Humphreys More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002010.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To describe the outcomes and quantify the rate of uric acid stone medical dissolution therapy using automated, software-generated stone volume measurements METHODS: A sample of patients treated with oral dissolution therapy was reviewed from a single institution between 2008 and 2019. Baseline patient demographics, metabolic urine testing and stone characteristics were collected. CT scan images were evaluated using the quantitative Stone Analysis Software (qSAS) to obtain total stone volume (TSV), maximum diameter (MD) and stone number. Rate of dissolution using TSV was calculated over the treatment period. RESULTS: A total of 27 patients were started on oral dissolution therapy, corrected for renal function. After mean treatment duration of 180 days (range 41-531), 16 patients failed treatment due to intolerance (2), lack of pH change (2), compliance with medication (6) and resistance of stone (6), resulting in surgical therapy. Twenty stones in 11 patients showed complete (CD) or partial dissolution (PD) and were analyzed with the qSAS software. Compared to those who failed treatment, CD and PD patients had lower 24 h urinary uric acid (0.6 vs. 1.7 g/day, p=0.025) and higher treatment urine pH (6.8 vs 5.9, p<0.001). Pre-treatment stone burden had a MD 16.6 mm (range 4.5-40.4), TSV 1014 mm3 (range 27-4939) and attenuation 354.8 HU (range 22-455). Thirteen (65%) stones showed CD on imaging. Time to CD was 167.6 days (SD 82.9, range 41-312). CD patients had a significantly lower HU than PD (291.8 vs. 392 HU, p=0.005). Rate of change for responders was 4.73 mm3 or 0.6% of TSV per day. Time to dissolution of 50% of stone volume based on TSV was 86 days (12.30 weeks). MD overestimated the time to 50% of stone volume by 72.1 days (10.3 weeks). CONCLUSIONS: Use of software-calculated TSV is an effective method of measuring uric acid stone response to oral alkalization therapy. Stone volume decreased by 50% after 12.3 weeks of treatment. Further studies with a larger sample are needed to confirm if this can be used to guide surveillance schedules for dissolution therapy. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e373-e373 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jonathan Moore More articles by this author Amihay Nevo More articles by this author Saif Salih More articles by this author Haidar Abdul-Muhsin More articles by this author Mira Keddis More articles by this author Karen Stern More articles by this author Mitchell Humphreys More articles by this author Expand All Advertisement Loading ...