Urinary Stone Composition Research Articles

Analysis of Urinary Stone Composition: A Retrospective Single Center Study during the Last Five Years (2009-2013)

Purpose Analysis of urinary stone composition is essential for treatment and prevention of urolithiasis. We evaluated the effect of age, gender, and stone location on urinary stone components during the last five years. Materials and Methods We conducted a retrospective analysis of the medical records of 375 patients ranging in age from 15 years old to 93 years old (241 males and 134 females) who underwent conventional or endoscopic surgery, shock wave lithotripsy, or passed their stones spontaneously between 2009 and 2013. Stone analysis was performed using a chemical analysis method to determine the molecular composition of each stone. Results Of the 375 patients with urolithiasis, 152 patients (40.5%) had predominantly calcium oxalate, 85 patients (21.5%) had uric acid, 17 patients (4.5%) had calcium phosphate, 17 patients (4.5%) had magnesium ammonium phosphate, 16 patients (4.3%) had calcium carbonate, and 86 patients (22.9%) had mixed stone type. There was a decreasing prevalence of calcium oxalate stone with age group (42.5% in young adult (20-39 years, n=40), 45.0% in adult (40-60 years, n=151), and 32.7% in elderly (≥60 years, n=180) as opposed to increasing prevalence in uric acid stone (7.5% in young adult, 15.2% in adult and 32.2% in elderly). Uric acid stones were more common in males and in lower urinary tract stones. Conclusions In this study, the incidence of calcium oxalate decreased with age and that of uric acid increased with age and in male. In comparison of the results of previous studies for several decades, the incidence of uric acid increased in the last five years.

Urinary stone analysis on 12,846 patients: a report from a single center in China

We reported a retrospective review of the urinary stone compositions in 12,846 patients. Data on urinary stone compositions analyzed between January 2003 and December 2012 in our center were collected. Infrared spectroscopy was used for stone analysis. Predominant stone component was recorded. Patients were divided into four age groups: 0-18, 19-40, 41-60, and 61-92, and five categories by components. In order to determine the change of stone characteristics with respect to time, data were also divided into two periods, 2003-2007 and 2008-2012. A total of 12,846 stones were included in this study. The age of the patients ranged from 1 to 92 years with 7,736 males and 5,110 females. Stone made of single component was rare, 2.61%. Calcium oxalate stone was the most common component at 82.56%. Calcium oxalate and uric acid stones were more common in male than in female. The incidence of calcium phosphate stones and uric acid stones had increased during the past 5 years, while calcium oxalate stones decreased. We found the highest incidence of stone disease in the 41-60 years old group and the lowest in the 1-18 years old for both genders. Calcium oxalate was the dominant component in every group but was more prevalent in 19-40 years group. The percentage of magnesium ammonium phosphate stone and uric acid stone increased with age.

Differentiating Calcium Oxalate and Hydroxyapatite Stones In Vivo Using Dual-Energy CT and Urine Supersaturation and pH Values

Knowledge of urinary stone composition can guide therapeutic intervention for patients with calcium oxalate (CaOx) or hydroxyapatite (HA) stones. In this study, we determined the accuracy of noninvasive differentiation of these two stone types using dual-energy CT (DECT) and urine supersaturation (SS) and pH values. Patients who underwent clinically indicated DECT scanning for stone disease and subsequent surgical intervention were enrolled. Stone composition was determined using infrared spectroscopy. DECT images were processed using custom-developed software that evaluated the ratio of CT numbers between low- and high-energy images. Clinical information, including patient age, gender, and urine pH and supersaturation profile, was obtained from electronic medical records. Simple and multiple logistic regressions were used to determine if the ratio of CT numbers could discriminate CaOx from HA stones alone or in conjunction with urine supersaturation and pH. Urinary stones (CaOx n = 43, HA n = 18) from 61 patients were included in this study. In a univariate model, DECT data, urine SS-HA, and urine pH had an area under the receiver operating characteristic curve of 0.78 (95% confidence interval [CI] 0.66-0.91, P = .016), 0.76 (95% CI 0.61-0.91, P = .003), and 0.60 (95% CI 0.44-0.75, P = .20), respectively, for predicting stone composition. The combination of CT data and the urinary SS-HA had an area under the receiver operating characteristic curve of 0.79 (95% CI 0.66-0.92, P = .007) for correctly differentiating these two stone types. DECT differentiated between CaOx and HA stones similarly to SS-HA, whereas pH was a poor discriminator. The combination of DECT and urine SS or pH data did not improve this performance.

Scanner and kVp dependence of measured CT numbers in the ACR CT phantom

Quality control testing of CT scanners in our region includes a measurement of CT numbers in the American College of Radiology (ACR) CT phantom using a standardized protocol. CT number values are clinically relevant in determining the composition of various tissues in the body. Accuracy is important in the characterization of tumors, assessment of coronary calcium, and identification of urinary stone composition. Effective quality control requires that tolerance ranges of CT number values be defined: a measured value outside the range indicates the need for further investigation and possible recalibration of the scanner. This paper presents the results of CT number measurements on 36 scanners (25 GE, 10 Siemens and 1 Toshiba) at each available kVp. Among the five materials (solid water, air, polyethylene, acrylic, bone‐equivalent) the measured CT numbers exhibit manufacturer and kVp dependence, which should be taken into account when defining tolerances. With this scan protocol, air and solid water values are significantly higher on GE scanners than on Siemens scanners (p‐value<0.01 at each kVp). The CT numbers of polyethylene and acrylic increase with kVp, while the bone‐equivalent CT number decreases. These results are used to define manufacturer‐ and kVp‐specific tolerance ranges for the CT numbers of each material in this phantom, which will be used in our quality control program.PACS numbers: 87.57.qp, 87.57.C‐

A Case of Ancient Bladder Stones from Oluz Höyük, Amasya, Turkey

A biological object was recovered from the pelvic region of an adult woman coded to SK13 unearthed from Oluz Höyük in Amasya, Turkey. The skeleton was dated to the medieval period on the basis of the burial customs and the calibrated 14C dates. The find was identified as a bladder stone on morphological, radiographic and chemo-analytical grounds with the help of X-ray diffraction, polarised energy dispersive X-ray fluorescence spectroscopy, confocal Raman spectroscopy, and microscopic techniques. The mineralogical composition of urinary stone was found to be as calcium phosphate (apatite). Bladder stone disease is endemic in poor agricultural regions where the typical diet is mostly based on grain carbohydrate consumption with scarce intake of animal protein. Copyright © 2013 John Wiley & Sons, Ltd.

Changes in upper urinary tract stone composition in Australia over the past 30 years

To investigate upper urinary tract stone composition rates in Australia To investigate changes in stone composition in Australia over the past 30 years The Institute for Clinical Pathology and Medical Research (ICPMR) database was used to obtain - stone composition statistics from 2009-2011 Historical comparisons of stone composition rates were obtained from previous Australian studies; Rofe; 1981, and Baker; 1993 for epidemiological data from the 1970s and 1980s respectively. Stone composition data was separated into gender and age-groups From the 791 stones analysed between 2009 and 2011, calcium oxalate remains the dominant type accounting for 64% of stones in our dataset, which compares to 68% from both the 1970s and 1980s. Uric acid stones contributed 16% of contemporary stone compositions, comparable to 16% in the 1970s and 17% in the 1980s. Struvite stones showed a decreasing trend from 14% in the 1970s, to 12% in the 1980s and 7% in the current data. For struvite stones, while the female 21-30 age-group was the most prolific for struvite stone formation in the 1980s, the peak group in contemporaneous records is 61-70 year-old men. Stone composition in Australia has remained relatively static over the past 30 years. Modifications in diet and body habitus have not resulted in significant changes in the proportion of uric acid and calcium oxalate stones detected. The decreasing trend in the proportion of struvite stones most likely reflects improved management of urinary tract infections within the Australian population.

High incidence of urinary stones in Uyghur children may be related to local environmental factors

ObjectiveTo analyze the causes of urolithiasis in Uyghur children from Xinjiang. Patients and methodsWe retrospectively evaluated the clinical features and characteristics of urinary stone composition of 220 Uyghur pediatric patients with urolithiasis between March 2009 and June 2011. The data were compared with that of 100 Uyghur children without urolithiasis who visited the Child Care Clinic for regular health check-ups. The stones were collected by endoscopy or open surgery, and analyzed using infrared spectroscopy. ResultsThe mean age of the 220 Uyghur children was 7.48 ± 4.73 years (range, 0.8–17.0 years). The overall sex ratio (male:female) was 2.23:1. The predominant pure stone was ammonium urate (58.9%), whereas the predominant mixed stone was calcium oxalate mixture (91.1%). Uric acid stones comprised 54% of all stones. Urinary tract infections were observed in 42.3% and 4.0% of the patient and control groups, respectively. The mean urinary pH values were 5.77 ± 0.67 and 6.42 ± 0.67, respectively (p < 0.001). pH values were <5.5 in 52.7% and 6% of the patient and control groups, respectively. On 24-h urine analysis, we found metabolic disturbances in these patients: hypercalciuria in 6.8% cases, hyperphosphaturia in 16.8% cases, hyperuricosuria in 21.4% cases, and hypomagnesiuria in 34.1% cases. ConclusionsUrolithiasis in Uyghur children may be primarily related to local environmental factors.

E140 Spectral analysis of urinary stone composition during laser fragmentation – evaluation of an experimental system

E140 Spectral analysis of urinary stone composition during laser fragmentation – evaluation of an experimental system

E158 Urinary stone composition analysis – five-year experience of a major Portuguese urological center

E158 Urinary stone composition analysis – five-year experience of a major Portuguese urological center

E146 Role of computed tomography in predicting urinary stone composition

E146 Role of computed tomography in predicting urinary stone composition

Urinary stone composition in Israel: current status and Variation with age and Gender-A bicenter study

Urinary stone composition in Israel: current status and Variation with age and Gender-A bicenter study

Urinary Stone Composition in Israel: Current Status and Variation with Age and Sex—A Bicenter Study

The epidemiologic data regarding stone composition in Israel are based on anachronistic methods of stone analysis. Historically, Israel was noted for an unusually high percentage of uric acid stones. The aim of the study was to describe the current stone composition distribution in Israel, using modern techniques of urinary stone analysis. Age and sex correlations were investigated. In a bicenter study, using infrared spectroscopy and X-ray diffraction, stones from five hundred and thirty eight (538) patients were analyzed and demographic data recorded. The study cohort included 401 men (74.5%) and 137 women (25.5%) with a male to female ratio of 2.9:1 and a median age of 48 years (range 2-85 years). While calcium oxalate monohydrate was the predominant component in both sexes, it was lower in female patients (77.3% vs 65%). The rate of infection stones (struvite+carbonate apatite) was significantly higher in women (35.7% vs 10.2%). Uric acid stones were found in only 14.5% of the patients and increased with age. Conversely, the rate of calcium oxalate dihydrate decreased with age. Modern techniques of urinary stone analysis showed that the most frequent stone component in Israel is calcium oxalate monohydrate. In contrast to earlier reports and in accordance with reports from other countries, the overall frequency of uric acid is 14.5%. With age, the frequency of uric acid increases reaching 21% in persons >60 years old. A significant sex difference was noted in the distribution of calcium oxalate stones and infection stones. The classic 3:1 ratio was maintained, however.

Editorial Comment

The authors present data describing the composition and geographic distribution of urolithiasis in Turkey. This interesting study examined the composition of 6453 stones and compared their incidence to both the geographic region in Turkey and gender. Understanding the epidemiology of urolithiasis in all regions is important in the prevention of stone recurrence, particularly in the face of increasing stone incidence and expenditures in recent years. 1 Pearle M.S. Calhoun E.A. Curhan G.C. Urologic Diseases of America ProjectUrologic diseases in America project: urolithiasis. J Urol. 2005; 173: 848-857 Abstract Full Text Full Text PDF PubMed Scopus (632) Google Scholar Stone Compositions in Turkey: An Analysis According to Gender and RegionUrologyVol. 82Issue 3PreviewTo evaluate the compositions of the kidney stones obtained from different regions of Turkey and to present the gender and regional differences. Full-Text PDF ReplyUrologyVol. 82Issue 3PreviewWe appreciate the comments on our study on the urinary stone composition and its geographic distribution in Turkey. Full-Text PDF

This Month in Adult Urology

No AccessJournal of UrologyThis Month in Adult Urology1 Nov 2013This Month in Adult Urology William D. Steers William D. SteersWilliam D. Steers More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.08.001AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "This Month in Adult Urology." The Journal of Urology, 190(5), pp. 1629–1630 References 1 : Risk of urinary incontinence following post-brachytherapy transurethral resection of the prostate and correlation with clinical and treatment parameters. J Urol2013; 190: 1805. Link, Google Scholar 2 : Testosterone supplementation does not worsen lower urinary tract symptoms. J Urol2013; 190: 1828. Link, Google Scholar 3 : Population based study of use and determinants of active surveillance and watchful waiting for low and intermediate risk prostate cancer. J Urol2013; 190: 1742. Link, Google Scholar 4 : The predictive value of endorectal 3 Tesla multiparametric magnetic resonance imaging for extraprostatic extension in patients with low, intermediate and high risk prostate cancer. J Urol2013; 190: 1728. Link, Google Scholar 5 : Automated analysis of urinary stone composition using Raman spectroscopy: pilot study for the development of a compact portable system for immediate postoperative ex vivo application. J Urol2013; 190: 1895. Link, Google Scholar 6 : Male breast cancer and 5α-reductase inhibitors finasteride and dutasteride. J Urol2013; 190: 1811. Link, Google Scholar © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 190Issue 5November 2013Page: 1629-1630 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information William D. Steers More articles by this author Expand All Advertisement PDF downloadLoading ...

Automated Analysis of Urinary Stone Composition Using Raman Spectroscopy: Pilot Study for the Development of a Compact Portable System for Immediate Postoperative Ex Vivo Application

We evaluate a compact portable system for immediate automated postoperative exvivo analysis of urinary stone composition using Raman spectroscopy. Analysis of urinary stone composition provides essential information for the treatment and metaphylaxis of urolithiasis. Currently infrared spectroscopy and x-ray diffraction are used for urinary stone analysis. However, these methods may require complex sample preparation and costly laboratory equipment. In contrast, Raman spectrometers could be a simple and quick strategy for immediate stone analysis. Pure samples of 9 stone components and 159 human urinary calculi were analyzed by Raman spectroscopy using a microscope coupled system at 2 excitation wavelengths. Signal-to-noise ratio, peak positions and the distinctness of the acquired Raman spectra were analyzed and compared. Background fluorescence was removed mathematically. Corrected Raman spectra were used as a reference library for automated classification of native human urinary stones (50). The results were then compared to standard infrared spectroscopy. Signal-to-noise ratio was superior at an excitation wavelength of 532nm. An automated, computer based classifier was capable of matching spectra from patient samples with those of pure stone components. Consecutive analysis of 50 human stones demonstrated 100% sensitivity and specificity compared to infrared spectroscopy (for components with more than 25% of total composition). Our pilot study indicates that Raman spectroscopy is a valid and reliable technique for determining urinary stone composition. Thus, we propose that the development of a compact and portable system based on Raman spectroscopy for immediate, postoperative stone analysis could represent an invaluable tool for the metaphylaxis of urolithiasis.

Using 24-Hour Urinalysis to Predict Stone Type

We determined the accuracy of 24-hour urinalysis in predicting stone type and identify the associations between 24-hour urine elements with stone type. We performed a retrospective review of 503 stone formers with stone composition analysis and 24-hour urinalysis available. Analysis of 24-hour urine elements across stone types was performed using Fisher's exact test and ANOVA. Multinomial logistic regression was used to predict stone type based on 24-hour urinalysis. A total of 280 (56%) patients had predominantly calcium oxalate, 103(20%) had uric acid, 93 (19%) had calcium phosphate, 16 (3%) had mixed and 11(2%) had other stone types. There were several significant patient characteristics and 24-hour urinalysis differences across stone type groups. The statistical model predicted 371 (74%) calcium oxalate, 78 (16%) uric acid, 52 (10%) calcium phosphate, zero mixed and 2 (less than 1%) other stone types. The model correctly predicted calcium oxalate stones in 85%, uric acid in 51%, calcium phosphate in 31%, mixed in 0% and other stone types in 18% of the cases. Of the predicted stone types, correct predictions were 61%, 69%, 56% and 71% for calcium oxalate, uric acid, calcium phosphate and other stones types, respectively. The overall accuracy was 64%. Plots were used to explore the associations between each 24-hour urine element with each predicted stone type adjusted for all the others urinary elements. A 24-hour urinalysis alone does not accurately predict stone type. However, it may be used in conjunction with other variables to predict stone composition.

Chemical composition and binary mixture of human urinary stones using FT-Raman spectroscopy method

In the present study the human urinary stones were observed in their different chemical compositions of calcium oxalate monohydrate, calcium oxalate dihydrate, calcium phosphate, struvite (magnesium ammonium phosphate), uric acid, cystine, oxammite (ammonium oxalate monohydrate), natroxalate (sodium oxalate), glushinkite (magnesium oxalate dihydrate) and moolooite (copper oxalate) were analyzed using Fourier Transform-Raman (FT-Raman) spectroscopy. For the quantitative analysis, various human urinary stone samples are used for ratios calculation of binary mixtures compositions such as COM/COD, HAP/COD, HAP/COD, Uric acid/COM, uric acid/COD and uric acid/HAP. The calibration curve is used for further analysis of binary mixture of human urinary stones. For the binary mixture calculation the various intensities bands at 1462cm−1 (ICOM), 1473cm−1 (ICOD), 961cm−1 (IHAP) and 1282cm−1 (IUA) were used.

Pitfalls in urinary stone identification using CT attenuation values: Are we getting the same information on different scanner models?

IntroductionEvaluate the capability of different Computed Tomography scanners to determine urinary stone compositions based on CT attenuation values and to evaluate potential differences between each model. Methods241 human urinary stones were obtained and their biochemical composition determined. Four different CT scanners (Siemens, Philips, GEMS and Toshiba) were evaluated. Mean CT-attenuation values and the standard deviation were recorded separately and compared with a t-paired test. ResultsFor all tested CT scanners, when the classification of the various types of stones was arranged according to the mean CT-attenuation values and to the confidence interval, large overlappings between stone types were highlighted. The t-paired test showed that most stone types could not be identified. Some types of stones presented mean CT attenuation values significantly different from one CT scanner to another. At 80kV, the mean CT attenuation values obtained with the Toshiba Aquilion were significantly different from those obtained with the Siemens Sensation. On the other hand, mean values obtained with the Philips Brilliance were all significantly equal to those obtained with the Siemens Sensation and with the Toshiba Aquilion. At 120kV mean CT attenuation values of uric acid, cystine and struvite stones obtained with the Philips model are significantly different from those obtained with the Siemens and the Toshiba but equal to those obtained with the GE 64. ConclusionsAccording to our study, there is a great variability when different brands and models of scanners are compared directly. Furthermore, the CT scan analysis and HU evaluation appears to gather insufficient information in order to characterize and identify the composition of renal stones.

Determination of urinary stone composition using dual-energy spectral CT: Initial in vitro analysis

To evaluate the feasibility of determining the chemical composition of urinary stones using computed tomography (CT) spectral imaging (SI) MATERIALS AND METHODS: Two hundred and ten urinary stones were scanned in vitro using the SI mode and conventional polychromatic imaging (CPI; 120 kVp) mode. The radiodensity at 50 keV and 120 kVp, the mean calcium density (CD), and the water density (WD) were measured using the 50 keV images, 120 kVp images, calcium-based images, and water-based images, respectively. These parameters and the calcium-water ratio (CWR) were compared between different types of stones. CWR was defined as: CWR = ‌calcium density/water density‌. According to the results determined by infrared spectroscopy, 116 pure urinary stones were divided into five groups: uric acid (UA, n = 16), struvite (STR, n = 23), cystine (CYS, n = 10), calcium phosphate (CaP, n = 29), and calcium oxalate (COX, n = 38). CD, CWR, and the radiodensity of stones at 50 keV CT imaging of each group were as follows: UA (-3.55 ± 10.85 mg/ml, 0.03 ± 0.05, 510.08 ± 157.29 HU); STR (224.99 ± 64.28 mg/ml, 0.19 ± 0.07, 1058.58 ± 260.13 HU); CYS (139.67 ± 34.66 mg/ml, 0.13 ± 0.03, 725.75 ± 142.35 HU); CaP (619.39 ± 26.13 mg/ml, 0.69 ± 0.11, 2617.46 ± 186.22 HU); COX (518.61 ± 95.5 mg/ml, 0.58 ± 0.1, 2247.47 ± 379.51 HU). The differences in the CD, CRW, and radiodensity of stones at 50 keV CT imaging among the groups were statistically significant by binary comparison (p < 0.05). There were no significant differences in the radiodensity of stones at 120 keV CT imaging between UA and CYS (p = 0.267), CaP and COX (p = 0.065), and in the WD between STR and CYS (p = 0.108). SI provides a novel method to better characterize pure urinary stones using the mean CD, CWR, and the radiodensity of stones at 50 keV CT imaging.

436 Predicting Urinary Stone Composition – a radiological study made by urologists

436 Predicting Urinary Stone Composition – a radiological study made by urologists