Common Type Of Stone Research Articles

Initial experience of percutaneous nephrolithotomy surgery in secondary hospital in Bali

Background. The formation of kidney stones is the result of the accumulation of crystals within the kidneys. Percutaneous nephrolithotomy (PCNL) is the preferred method for treating stones larger than 2 cm. This study aims to analyse outcomes and experiences of PCNL for kidney stone removal. Materials and methods. It was a descriptive study with a cross-sectional design, utilizing secondary data from electronic medical records in Klungkung General Hospital. There are 91 samples collected using total sampling between October 2020 and August 2023. The analysis was conducted using the SPSS Statistics 26. Results. The 51–60 age group (38.5 %) exhibited the highest prevalence of patients undergoing PCNL surgery. The most common type of stone was solitary (48.4 % of cases), with an average size of 3.570 ± 1.159 cm. The mean duration of the procedure was 38.630 ± 21.667 minutes, with a single puncture utilized in 68.1 % of cases. The pain levels experienced were generally low, with a mean score of 2 on a 10-point scale. The mean length of hospital stay was 2.330 ± 1.012 days. The outcomes of PCNL in patients with kidney stones were favourable, with a high stone-free rate of 92.3 % and minimal complications. Рostoperative complications were infrequent. Conclusions. It is suggested that PCNL is an effective and safe procedure for kidney stone removal.

Proof-of-concept for a novel nanotechnology-based treatment for urolithiasis

Proof-of-concept of photonic lithotripsy in an in vitro setting and its ability to fragment the most common stone types is demonstrated. Effectiveness of different classes of photonic nanoparticles in fragmenting human stones is assessed. De-identified human stones were collected after institutional approval. Stones of a size range between 2–4 mm were rehydrated in simulated urine for 24 h. Stones were then coated with a solution of nanoparticles prior to activation with either a 785 nm or 1320 nm near-infrared energy source. Photonic lithotripsy achieved greater than 70% success rate in fragmentating calcium oxalate monohydrate stones using carbon-based nanoparticles for both near-infrared wavelengths. For gold-based nanoparticles, there was a similar success rate with the 785 nm wavelength but a significant decrease when using the 1320 nm wavelength energy source. All stones fragmented with the energy source at a distance ≥ 20 mm from the stone’s surface. Limitations include the use of mixed-composition stones, a lack of complete stone immersion in liquid during treatment, and smaller stone size. Different classes of nanoparticles when excited with a near-infrared energy source can fragment common stone types in vitro. This technology has the potential to change the way we approach and treat patients with urolithiasis in a clinical setting.

Chemical Composition of Calculi Removed from Urinary Tract

Urinary stone (calculi) disease is the most prevalent occurrence in the outpatient urology department by far. It is becoming more and more commonplace. Since most of the calculi might recur, understanding chemical composition is crucial. worldwide. Objective: To analyze the different compositions of calculi removed from urinary tract. Methods: A descriptive study was performed in the Department of Urology, Avicenna Medical College and Hospital, Lahore, from July 2016 to October 2022. 300 Patients operated for urinary stone disease were selected as the sample population. All calculi removed from these patients were subjected to stone analysis and then results were prepared. Results: The most common stone type based on chemical composition was calcium oxalate (52%), followed by uric acid stones (25%), mixed stones (17%) and magnesium ammonium phosphate MAP (5%). Other less common types were accountable for only 1%. Conclusions: Calcium oxalate, uric acid and mixed composition stones are most common varieties in the draining area of our hospital setup.

A novel in vivo model of ureteral fibrosis induced by calcium oxalate beads in C57BL/6J mice.

The global incidence of ureteroliths in humans is increasing, particularly posing a problem in developed countries. The most common stone type is calcium oxalate, which is associated with a high recurrence rate. In veterinary medicine, stones are the most common cause of ureteral obstruction in cats, accounting for 72-87% of cases. In cats, stones cause irreversible ureteral damage, necessitating stone treatment as well as ureteral therapy. However, the mechanisms underlying the ureteral damage caused by stones remain unclear. Therefore, this study aimed to create a mouse model suitable for studying the ureteral fibrosis caused by oxalate stones by artificially embedding calcium oxalate in the ureter. Pathological tissue analysis was used to compare normal ureters without ligation and ureters with sham or oxalate bead implantation. The ureters of the sham and oxalate bead groups showed granulation tissue formation, transitional epithelium exfoliation, and densely packed connective tissue in the proprietary and muscle layer regions. Particularly in the oxalate bead group, infiltration of degenerated neutrophils, presence of foreign body giant cells, and hyperplasia of the transitional epithelium were observed. The proportion of fibrosis was higher in the oxalate group than in the sham group. Overall, this mouse model created using oxalate bead implantation has the potential to efficiently induce ureteral obstruction. This mouse model is expected to be used for elucidating the molecular mechanisms of ureteral fibrosis and evaluating therapeutic drugs in future.

Mechanistic Framework of Herbs and Phytoconstituents used Against Experimentally Induced Urolithiasis

Urolithiasis, the term is referred to as the process of formation of stones in the urinary system and is a complex process that results in the development of a succession of several physicochemical steps i.e., supersaturation, nucleation, growth, aggregation, and retention within the kidneys. Urolithiasis is a multi-factorial etiopathogenesis involving anatomical, metabolic, genetic, nutritional, infections, environmental and socio-economic factors. Different types of calculi (calcium oxalate, struvite, uric acid and cystine stones etc.,) have been identified and among which the common type of stone found is calcium oxalate-type crystals. A person with urolithiasis may experience nausea, vomiting, severe pain in the side and back and in the process of urination. The medical management of urolithiasis is mainly caused by procedures like percutaneous nephrolithotomy and Extracorporeal Shock Wave Lithotripsy (ESWL) techniques. But these procedures can cause undesirable side effects such as the development of tubular necrosis, hypertension, haemorrhage, and later fibrosis of the kidney leading to cellular injury and the reappearance of the formation of renal stones. Thus, there is an essential for more effective alternative therapy, which corrects the events of stone formation. Treatment with synthetic drugs has shown many side effects. Some synthetic drugs may cause nephrotoxicity. In India, medicinal plants/herbs have been in use to treat various diseases since ancient times. These plant-based derivatives are stated to be effective in decreasing the recurrence rate of renal stones without any side effects and minimizing toxic free radical generation by radical scavenging action. This review discussed the mechanisms of various medicinal plants and their phytoconstituents in experimentally induced urolithiasis in preclinical models.

Metabolic evaluation of high-risk stone formers: a retrospective study

BackgroundThe purpose of this study was to assess the metabolic abnormalities in high-risk stone formers.MethodsThis was a retrospective observational study done at Tribhuvan University Teaching Hospital, Nepal, over 1-year period. High-risk stone formers were identified and were evaluated with serum chemistries and 24-h urinary chemical evaluation. Stone analysis was also included whenever available. Common metabolic abnormalities and stone analysis results were reported and compared with different studies. Continuous variables were expressed as mean ± SD. Categorical variables were expressed as percentage and proportions.ResultsDuring 1 year of period, sixty-five patients had undergone extensive metabolic evaluation, but complete data were available for only forty-six patients. Of the total patients (n = 46), 63% were male (n = 29) and rest (36.9%) were female. Mean age of patients was 34.4 ± 15.1 years. Common reasons for metabolic evaluation were multiple stones (40%), bilateral stones (27%), recurrent stones (17%) and others (16%). Most common stone type was mixed stone with predominant composition being calcium oxalate mono- and dihydrate (62.9%). Twenty-four-hour urinary metabolic evaluation showed hyperoxaluria (32.6%) as most common abnormalities followed by hypocitraturia (21.7%) and hypocalciuria (21.7%).ConclusionHyperoxaluria and hypocitraturia are common metabolic abnormalities in our patients. These findings help in counselling dietary measures to patients.

Tribulus Terrestris and its Efficacy in the Treatment of Urinary Calculi

Background: Urolithiasis as the third most common disorder is defined as stones within the urinary tract. Calcium oxalate is the most common type of stone with a prevalence of 80-85% of cases. There is no drug treatment for urolithiasis, but the use of some stone blockers and inhibitors relaxes the ureter smooth muscles and helps the stone excretion. Objective: High prevalence and recurrence rates of urolithiasis has encouraged scientists to find new drugs, especially from medicinal plants. Tribulus terrestris is used for the management of urinary calculi in different traditional systems. Therefore, the potential use of T. terrestris in the management of urinary stones has been the subject of this review for the first time. Methods: The manuscript was prepared by searching the keywords “Tribulus terrestris”, “urolithiasis”, “urinary stone”, and “calcium oxalate” in scientific resources, traditional and modern books, dissertations, and documents. Results: The results exhibited that T. terrestris fruit aqueous extract had some efficacy in the treatment of urinary calculi by demineralizing the stone, inhibiting the stone formation, increasing urine volume in 24 hrs in animal and human studies, along with protective effects against renal injury due to inhibition of oxidative stress and lipid peroxidation. Conclusion: All these mechanisms make T. terrestris as an effective treatment for urolithiasis that needs to be evaluated in further clinical studies.

Chemical Analysis Study of Kidney Stones in Iraqi Community

The urinary tract system is one of the most important system in human body to control many functions and get any wastes out of body, many diseases may affect this function and prevents it to work effectively. One of this disease is nephrolithiasis at which salt forming stone are settled in renal system affecting its work. The qualitative biochemical analysis of compositions of each stone was done for carbonate, calcium, magnesium, phosphate, oxalate, uric acid, and cysteine, using stone powder derived from the stones. These results found that Calcium oxalate stones were more likely to be detected in patients with upper urinary tract stones (p < 0.001). It was observed in 5.3% of cases which was apparently lower than previous data in nationwide urinary stone composition analysis. the most common type of stone was calcium oxalate (84.1%); others were calcium oxalate phosphate (8.0%), ammonia (3.4%), calcium uric acid (2.3%) and calcium carbonate (1.1%). A defect in ammonium excretion would account for the undue urinary acidity; then, increased urine acidity promotes uric acid super saturation. The amount of urinary oxalate excretion is a significant factor in the development of CaOx stones. Aim of study to know how to prevent stone recurrence and formation requiring better knowing mechanisms contributed in this stone formation.

Comparison of infants and children with urolithiasis: a large case series.

We evaluated the demographic features, etiologic risk factors, treatment strategies, and outcome of the infants and children with urolithiasis (UL). A retrospective multicenter study was conducted including 23 Pediatric Nephrology centers in Turkey. The medical records of 2513 children with UL were reviewed. One thousand, three hundred and four boys and 1209 girls (1.1:1) were reported. The mean age at diagnosis was 39.5 ± 35months (0.4-231months), and 1262 patients (50.2%) were in the first year of life (infants). Most of the cases with infantile UL were diagnosed incidentally. Microlithiasis (< 3mm) was found in 794 patients (31.6%), and 64.5% of the patients with microlithiasis were infants. Stones were located in the pelvis-calyces in 63.2% (n: 1530) of the cases. The most common stone type was calcium oxalate (64.6%). Hypocitraturia was the most common metabolic risk factor (MRF) in children older than 12months, but in infancy, hypercalciuria was more common. Fifty-five percent of the patients had received at least one medical treatment, mostly potassium citrate. At the end of a year's follow-up, most of the patients with microlithiasis (85%) showed spontaneous remission. The rate of spontaneous stone resolution in infants was higher than in children. Spontaneous remission rate was higher in cases with MRF (-) stones than in MRF ( +) stones. However, remission rate with medical treatment was higher in cases with MRF ( +) stones. This study represents the results of a large series of infants and children with UL and showed that there are several differences such as underlying metabolic and anatomic abnormalities, clinical course, and stone remission rates between infants and children with urinary stone disease.

English

BACKGROUND Dual energy computed tomography (DECT) is a new method of computed tomography (CT) imaging which allows to determine stone composition in addition to assessing stone morphology. The purpose of this study was to evaluate the role of dual energy CT (DECT) preoperatively to assess the composition of urinary stones and to compare it with post-operative in vitro qualitative chemical analysis as reference standard. METHODS Forty patients (18 male and 22 female) who presented with symptoms of renal stones in the department of urology were included in the study. All 40 patients who were diagnosed to have renal stones clinically and by ultrasonography (USG) kidney, ureter and bladder (KUB) region were subjected to dual energy CT. The stone composition assessed in vivo using DECT preoperatively and in vitro by chemical analysis post operatively after stone extraction by surgical procedure. The results were compared by statistical analysis. Sensitivity, specificity and positive predictive value (PPV) were calculated and descriptive study done using Statistical Package for Social Sciences (SPSS) 20.00 version. Data was analysed by comparing it with correlative qualitative chemical analysis. RESULTS In our study, in vivo analysis using DECT showed most common type of stone was calcium oxalate seen in 20 cases compromising 50 % of total cases. Next common stone type was uric acid stone (22.5 %) followed by cysteine (17.5 %) and calcium hydroxyapatite (10 %) respectively. When the same stones were subjected to ex vivo chemical analysis, one of the calcium oxalate stone came out to be calcium phosphate and one of the cysteine stone came out to be mixed stone. Thus, out of 40 stones, 38 stones were found to have the same result in ex vivo chemical analysis as that of in vivo analysis by dual energy CT. Hence, accuracy of dual energy CT in diagnosis of renal stones was found to be 100 % with CI 91.19 % - 100 %. CONCLUSIONS With dual energy CT, it is possible to determine the composition of renal calculi in vivo non-invasively (with specificity of 100 % in our present study). Therefore, this helps in deciding the modality of treatment pre-operatively whether the stone is amenable to medical management (e.g., Uric acid stones) or requires extracorporeal shock wave lithotripsy (ESWL) or surgical intervention can be determined preoperatively. This helps to reduce the unnecessary financial burden and is found to be time saving. KEYWORDS Renal Calculus, Dual Energy CT, Stone Composition, Uric Acid Stones, Non-Uric Acid Stones, Attenuation, Hounsfield Units HU, Chemical Analysis of Stones.

Influence of Age and Geography on Chemical Composition of 98043 Urinary Stones from the USA

BackgroundUrolithiasis is a growing issue globally, but it is heterogeneous, with a different epidemiology and pathophysiology for each different stone composition. ObjectiveThe purpose of this study is to describe the incidence of urinary stones in the USA from 2016 to 2019 by chemical composition and to investigate the influence of age and geography on these stone types. Design, setting, and participantsWe obtained compositional analyses for all urinary stones submitted to a national laboratory over an approximately 3-yr period. Outcome measurements and statistical analysisData collected included the chemical constituents of a stone, patient age, and geographical origin. We describe the incidence of each stone type by frequency. Statistical testing was performed to determine the influence of age and geographical region on overall incidence of each stone composition. Results and limitationsIn total, 99908 specimens were analyzed. When pure stones were ordered by frequency, we found that the most common stone type was calcium oxalate (CaOx) (79.2%), followed by uric acid (UA; 14.3%), calcium phosphate (CaPO4; 3.7%), cystine (0.51%), drug induced (0.12%), and magnesium ammonium phosphate (0.04%). CaOx, UA, and CaPO4 were often mixed with one another. Among CaOx stones, the plurality (28.0%) was made of pure calcium oxalate monohydrate (COM), and only 0.002% was pure calcium oxalate dihydrate. There was an overall association between stone composition and both geographical distribution and age (p < 0.001). ConclusionsCaOx stones comprise the majority of urinary stones in the USA, of which almost 28% were pure COM. Additionally, age and geographical region are significantly associated with variations in stone composition. Patient summaryWe evaluated the incidence of urinary stones in the USA based on their chemical composition. The most common stone type was calcium oxalate, the majority of which was pure calcium oxalate monohydrate. We also found age and geographical region to be significantly associated with variations in stone composition.

The stone crescent of Anatolia.

To assess the largest stone composition data available and to present the variations in the stone composition according to gender and different climatic environments in Turkey. Data for a total of 24768 urinary stone patients from the Turkish Mineral Research and Exploration Institute were evaluated. X-ray diffraction crystallography was used for analysis and the Köppen-Trewartha classification was used to assess the climatic features of the cities. After the assessment, the cities were divided into two groups-those with a continental climate (Dc) were defined as inland areas and the others (Non-Dc) were defined as coastal areas. The male-to-female ratio was 2.2:1. Amongst the patients, 53.7% had pure stones, while 46.3% had mixed-type stones. The most common type of stone was calcium oxalate in both pure and mixed stone groups. Given the climate patterns, the stone ratio between regions with a Dc climate and a Non-Dc climate was approximately 2:3. Cystine and uric acid stones were observed more frequently in inland regions, while calcium oxalate, whewellite, and struvite stones were observed more frequently in coastal areas (P=.005, P<.001, P<.001, P=.002, P=.002, respectively). Calcium oxalate stones were found at a higher rate in men, while cysteine, struvite, and calcium phosphate stones were more common in women (P<.001, P=.003, P<.001, P<.001, respectively). This study provides the most comprehensive data on the stone disease in Turkey. Considering the distribution of stone disease in Turkey, the frequency of analysed stones had parallels with the temperature averages and climate features, presenting crescent-like distribution.

MP03-07 URINARY STONE COMPOSITION IN THE UNITED STATES

INTRODUCTION AND OBJECTIVE: There is a paucity of large-scale data on urinary stone composition in the United States. Here, we present characteristics of urinary stone composition, age and geographic region in the United States. METHODS: We obtained compositional analyses for all urinary stones submitted to a reference laboratory from July 15, 2016 to Sept. 29, 2019. Stone composition was determined by integrative crystallography. Stones containing >90 percent of particular chemicals were classified as purely made of that composition. Data was analyzed using Stata 16 (College Station, Texas) software. RESULTS: Total of 99,908 records of stones were analyzed. Of this 98,043 were categorized as urinary stones and remaining were non-crystalline physiological particulate matter or artifacts. Common stone types were calcium oxalate (79.33%), uric acid (10.63%), calcium phosphate (5.73%) and triple phosphate (2.22%). Rare variety of stones included predominantly protein (0.93%), cystine (0.26 %) and drug induced (0.22%). Incidence of calcium oxalate and uric acid stones increased with age and that of calcium phosphate decreased with age. Amongst patient with calcium oxalate stone, incidence of calcium oxalate monohydrate increased with age and that of mixed calcium oxalate stones and calcium oxalate dihydrate decreases with age (p<0.01) (figure 1 and 2). Although the incidence of common stone types was similar, overall association between stone composition and geographical distribution was found to be statistically significant (figure 3). CONCLUSIONS: This series is the largest analysis to date of urinary stone composition in the United States. Age and geographical region were significantly associated with variations in stone composition.Source of Funding: NIL

Management of Pediatric Urolithiasis

Urolithiasis, the formation or presence of calculi in the urinary tract, is a broad term covering a multifaceted disease process with wide-ranging clinical and economic implications. Stones, often originating in the renal papillae, may be found from the renal parenchyma through the renal pelvis, ureter, or bladder. Stones can be composed of a multitude of molecules either in pure form or mixtures of several compounds. Historically considered a disease of adults, the prevalence of stones has increased among children. This review highlights pathophysiology of urolithiasis, common clinical presentations, work-up, and surgical and medical management of this increasingly common pediatric condition. The authors review the chemical pathways by which stones form, common stone types, common operative techniques, and epidemiology. This review contains 4 tables, and 59 references. Key Words: extracorporeal shockwave lithotripsy, kidney stones, lithotripsy, nephrolithiasis, percutaneous nephrolithotomy, pediatrics, renal calculi, ureteroscopy, urolithiasis

Identification of urine biomarkers for calcium-oxalate urolithiasis in adults based on UPLC-Q-TOF/MS

Urolithiasis is a common urological disease with a high morbidity and recurrence rate, of which calcium oxalate (CaOx) is the most common type of stone that underlies the disease. However, the potential metabolic mechanisms of CaOx urolithiasis remain unclear. The present study aimed to seek potential biomarkers and metabolic mechanisms of CaOx urolithiasis in adults. Urine samples were collected from 36 healthy individuals and 36 patients diagnosed with bilateral upper-urinary-tract stones. All of the stones were composed of CaOx. Ultra-performance liquid chromatography coupled to quadrupole time-of-flight mass spectrometry (UPLC-Q-TOF/MS) was used to perform a metabolic fingerprinting analysis. Principal component analysis (PCA) and orthogonal partial least-squares determinant analysis (OPLS-DA) were carried out to analyze the multivariate data. There were 18 differential metabolites identified, which mainly involved caffeine, phenylalanine, galactose, and tyrosine metabolism. The results revealed potential urinary biomarkers, via metabolic fingerprinting of adults with CaOx urolithiasis, which may help to improve future metabolic evaluation of urolithiasis. The elucidated metabolic pathways may have potential applications as novel treatment targets of CaOx urolithiasis. Additionally, our study suggests that the UPLC-Q-TOF/MS platform may offer new insights into the pathobiology of urolithiasis.

MP03-12 WIELDING A STONE ANALYSIS TO ITS FULL POTENTIAL: CAN PATIENTS WITH CAOX STONE DISEASE BE TREATED BASED ON COM VS COD?

INTRODUCTION AND OBJECTIVES:Calcium oxalate (CaOx) is the most common stone type in the United States. Current AUA guidelines suggest that a 24-hour urine collections should be obtained in high-ris...

Kidney stone composition in the Kingdom of Saudi Arabia .

Urolithiasis is a globally-distributed disease; however, its prevalence varies across countries and regions. Countries in the Middle East have been reported to have particularly high nephrolithiasis prevalence rates. To date, however, we have an incomplete understanding of the composition of stones seen in this region. Therefore, we performed a study to characterize stone composition over a 14-year period in the Eastern Province of the Kingdom of Saudi Arabia (KSA). A retrospective review of all adult patients who had the composition of their upper urinary tract calculi analyzed at Johns Hopkins Aramco Healthcare (JHAH) between 1999 and 2013 was performed. Patient demographics and pathology results were obtained from the electronic medical record. A total of 1,747 stones were analyzed in the study period. The results are presented in the Table. Male patients predominated (79%). For both men and women, the majority of stones were calcium oxalate: 85.2% male, 85.9% female. Uric acid stones were the next most common: 10.1% male; 9.0% female. Overall, there were no significant differences between gender with regards to the distribution of stone types. This study represents one of the largest characterizations of stone composition in the Middle East. There remains a significant gender disparity in stone prevalence in the Eastern Province of KSA, with males affected to a significantly greater extent. Calcium oxalate is the most common type of stone, and this is true for both men and women. Future investigations of dietary and environmental factors can build on these initial epidemiologic findings. .

A continuum of mineralization from human renal pyramid to stones on stems

The development of new modalities for kidney stone prevention rests upon understanding the progression of mineralization within the renal pyramid. The progression from small foci of mineralized volumes within the renal pyramid to larger interstitial plaques that ultimately lead into clinically detectable calcium-based stones on calcium phosphate stems will be presented through correlative microscopy approach. High resolution X-ray computed tomography (micro-XCT), electron microscopy, and energy dispersive X-ray (EDX) compositional analyses of interstitial plaques, stems, and attached stones were performed. Increase in mineral density progressed with mineralization severity, with the highest mineral densities detected within mature Randall’s plaque and stems to which kidney stones were attached. EDX analyses revealed variable elemental composition within interstitial plaque, stems, and stones. Micro-XCT reconstructions of stones with stems enabled visualization of unoccluded tubules within stems, with average tubule diameters corresponding to thin limbs of Henle, blood vessels, and collecting ducts. Correlative microscopy confirmed that the progression of mineralization leading to calcium-based nephrolithiasis occurs through a continuum involving four anatomically and structurally distinct biomineralization regions: 1) proximal intratubular mineralization within the renal pyramid; 2) interstitial Randall’s plaque near the tip of the papilla; 3) emerging plaque (stems); and, 4) the body of heterogeneous stones. Statement of SignificanceNephrolithiasis is a common condition affecting nearly 1 in 11 Americans. The most common type of stone, calcium oxalate is known to form on a calcium phosphate deposit on the renal papilla known as Randall’s plaque. Novel imaging techniques have identified distinct regions of biomineralization not just at the tip, but throughout the renal papilla. The classic understanding of Randall’s plaque formation is reformulated using correlative imaging techniques. This study establishes a stepwise progression of anatomically-specific biomineralization events including, 1) proximal intratubular mineralization within the renal pyramid; 2) interstitial Randall’s plaque near the tip of the papilla; 3) emerging plaque (stems); and, 4) the body of heterogeneous stones, and provides insights into the need for plausible site-specific therapeutic intervention.

Comparison of miniaturized percutaneous nephrolithotomy and flexible ureterorenoscopy for moderate size renal stones in elderly patients

Life expectancy has become longer, thus the number of elderly people who require treatment for nephrolithiasis has increased. We aimed to analyze the efficacy of flexible ureterorenoscopy (f-URS) and miniaturized percutaneous nephrolithotomy (mPNL) in the management of 10 and 30 mm renal stones in patients aged >60 years. In prospective non-randomized series, the data of patients who underwent f-URS or mPNL for kidney stones between July 2013 and July 2016 were analyzed. The procedure was accepted as successful if the patient was achieved complete stone clearance according to CT imaging between 1–3 months postoperatively. In total 60 patients and 58 patients were underwent f-URS and mPNL, respectively. The mean operation time, fluoroscopy time and hospitalization time were significantly shorter for the f-URS (p < 0.001, p < 0.001, p < 0.001, respectively). According to Clavien classification system, complication rates were not significantly different between the groups (p = 0.673). The stone-free rate was 81.7% for the f-URS group and 77.6% for the mPNL group after a single-session procedure (p = 0.747). Calcium oxalate monohydrate stones were the most common stone type in both groups. In multivariate analysis, multiple stones localization was only independent factor to predict complications. Our study had showed that both f-URS and mPNL are effective treatment modalities for 10–30-mm renal stones in elderly patients. Additionally, presence of stones in multiple location was the only predictive factor for complication development.

MP95-12 CHANGING LITHOGENIC TRENDS IN PATIENTS WITH NEUROLOGICALLY DERIVED MUSCULOSKELETAL DEFICIENCIES (NDMD)

You have accessJournal of UrologyStone Disease: Epidemiology & Evaluation II1 Apr 2017MP95-12 CHANGING LITHOGENIC TRENDS IN PATIENTS WITH NEUROLOGICALLY DERIVED MUSCULOSKELETAL DEFICIENCIES (NDMD) Lee Hugar, Ilan Kafka, Sara Sprauer, Michelle Yu, Thomas Fuller, Hassan Taan, Timothy Averch, and Michelle Semins Lee HugarLee Hugar More articles by this author , Ilan KafkaIlan Kafka More articles by this author , Sara SprauerSara Sprauer More articles by this author , Michelle YuMichelle Yu More articles by this author , Thomas FullerThomas Fuller More articles by this author , Hassan TaanHassan Taan More articles by this author , Timothy AverchTimothy Averch More articles by this author , and Michelle SeminsMichelle Semins More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.3014AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Patients with neurologically derived musculoskeletal deficiencies (NDMD), like spinal cord injury and spina bifida, are high risk for chronic complicated urolithiasis. Recent studies suggest that stone etiology in this population has shifted from purely infectious to mixed infectious/metabolic. We assess a cohort of NDMD patients for metabolic lithogenic risk factors, trends across etiology of NDMD, as well as trends across primary stone type. METHODS We conducted a retrospective cohort study of NDMD patients presenting to our dedicated ′stone clinic′ from 2000-2015. Patients with chemical stone and 24-hour urine analysis were included. Demographics, neurological deficiency, bladder management strategy, urine cultures, 24-hour urine, and stone composition were reviewed. RESULTS Seventy eight patients with NDMD and nephrolithiasis were identified. Of these, 26 had both chemical stone and 24 hour urine analysis. Positive urine cultures prior to treatment were present in 77%. Eighty-five percent of these cultures were positive for urea splitting organisms. The most common stone type categorized by primary composition was carbonate apatite (53.8%) followed by mixed apatite/oxalate (19.2%). When categorized by primary etiology, 61.5% were pure pH dependent (presumed to be infectious), 27% mixed pH dependent/metabolic, and 11.5% pure metabolic. Urinary citrate was significantly lower in patients with carbonate apatite, or pH dependent, calculi. Those with primarily calcium oxalate stones were significantly more likely to be obese (p=0.003), with a mean body mass index of 37. When stratified by gender, males were more likely to have hyperoxaluria. There was a trend toward positive cultures for urea splitting organisms and carbonate apatite stones in catheterized patients. Otherwise, there were no statistically significant differences in 24-hour urine parameters when stratified by gender, neurological deficiency, or bladder management strategy. CONCLUSIONS Among NDMD patients, metabolic factors may play a more significant role in stone formation than previously believed. There is still a high incidence of carbonate apatite stones, which could be attributed to bacteriuria and elevated pH. In addition to this, obesity, low volumes, low citrate, and elevated oxalate suggest a metabolic etiology. Identifying metabolic risk factors in NDMD patients is challenging but important; as it may significantly impact stone recurrence and the need for repeat surgery. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1290 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Lee Hugar More articles by this author Ilan Kafka More articles by this author Sara Sprauer More articles by this author Michelle Yu More articles by this author Thomas Fuller More articles by this author Hassan Taan More articles by this author Timothy Averch More articles by this author Michelle Semins More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...