Prevention Of Recurrent Stone Formation Research Articles

Текущий статус метафилактики мочекаменной болезни в Российской Федерации

Urolithiasis is one of the most common urological diseases in adults. Increased life expectancy of the population in developed countries, make urolithiasis topical issue and requires close attention. Due to the high risk of recurrent stone formation causing repeated surgical interventions, the issue of effective urinary stone metaphylaxis is very important today.To study the current state of the problem of urolithiasis metaphylaxis among Russian urologists, an anonymous questionnaire was applied. A 25-question questionnaire was sent to e-mail to more than 4,000 Russian urologists. A total of 1,238 specialists completed the questionnaire. The database compiled from the received responses was processed and presented with descriptive statistics in the form of tables and charts.According to the survey, more than half of the 831 (67.1%) specialists specialized in the treatment of urolithiasis. It was noted that 626 (86%) inpatient urologists and 205 (40%) outpatient urologists specialized in the treatment of urolithiasis. Only 521 (69.6%) urologists specializing in surgical treatment of urolithiasis give a patient a stone fragment to analyze its chemical composition. At the same time, half of the respondents reported that less than 10% of patients come to them for further metaphylaxis. One of the main reasons for not analyzing the chemical composition of the stone was the fact that 877 (70,84%) specialists indicated the inaccessibility of analysis under the state guarantee program, 503 (40,63%) specialists indicated the patients satisfaction with the results of minimally invasive surgical treatment and lack of sufficient motivation for further examinations. At the same time, less than 3% of specialists can perform stone analysis within the framework of the state guaranty program. 1180 (96,8%) respondents practiced the prophylaxis of recurrent calculi formation, but only 336 (28,47%) performed comprehensive metabolic examination of all patients followed by prescription of drug therapy and appropriate diet.Our survey revealed low involvement of urologists at the outpatient level in the process of conservative treatment and metaphylaxis of urolithiasis, low activity of urologists in performing complex metabolic study and comprehensive prevention of recurrent stone formation, low percentage of performing chemical composition analysis of stone and low activity of urologists in performing primary litholytic therapy of urate stones. Based on this analysis of the responses of most Russian urologists, it is possible to formulate recommendations to remove the obstacles to providing patients with urolithiasis with quality medical care in terms of conservative therapy and metaphylaxis of urolithiasis.

Effect of dietary treatment and fluid intake on the prevention of recurrent calcium stones and changes in urine composition: A meta-analysis and systematic review.

To perform a systematic review and meta-analysis of randomized controlled trials (RCTs) for investigating the effect of dietary treatment and fluid intake on the prevention of recurrent calcium stones and changes in urine composition. PubMed, Web of Science, Embase, EBSCO, and Cochrane Library databases (updated November 2020) were searched for studies with the following keywords: diet, fluid, recurrent, prevention, randomized controlled trials, and nephrolithiasis. The search strategy and study selection process was conducted by following the PRISMA statement. Six RCTs were identified for satisfying the inclusion criteria and enrolled in this meta-analysis. Our result showed that low protein with or without high fiber diet intervention does not decrease the recurrence of stone upon comparing with control groups (RR = 2.32, 95% CI = 0.42-12.85; P = 0.34) with significant heterogeneity among the studies (I2 = 81%, P = 0.02). But normal-calcium, low protein, low-salt diet had recurrences did reduced the recurrence compared to normal-calcium diet. And the fluid intake has a positive effect on prevention of recurrent stone formation (RR = 0.39, 95% CI = 0.19-0.80; P = 0.01) with insignificant heterogeneity among the studies (I2 = 9%, P = 0.30). The different components of urine at baseline were reported in four studies. Upon reviewing the low protein with or without high fiber dietary therapy groups, it was found that there were no obvious changes in the 24-hour urine sodium, calcium, citrate, urea, and sulfate. In conclusion, our study shows that the only low protein with or without fiber does not affect recurrence, but low Na, normal Ca diet has a marked effect on reducing recurrence of calcium stone. And fluid intake shows a significant reduction in the recurrence of calcium stone.

Инструменты IT-медицины в модификации образа жизни пациентов с мочекаменной болезнью

Introduction. Treatment and especially prevention of recurrent stone formation is a relevant topic for scientific research. One of the principles of metaphylaxis is lifestyle modification for example assessment and correction of food stereotypes, physical activity, sleep and rest mode, and rejection of bad habits. Materials and Methods. We analyzed the functionality of electronic tools available today for patients in the Russian Federation, such as: portable gadgets and medical devices. Results. The review presents modern technologies that allow monitoring, including remote monitoring, for patients with urolithiasis. Examples are given in the form of activity trackers, portable devices – urinary analyzers of various manufacturers, portable ultrasound devices, analyzers of the level of uric acid, nitrates, water hardness, «smart» scales. The spectrum of states in urolithiasis has been analyzed for the correct use of these devices. Conclusion. The technological innovations presented in this review open up new opportunities for increasing compliance in patients with urolithiasis. These innovations can become the basis for the implementation of the principles of «medicine 4P» on the example of urolithiasis for the implementation of promising opportunities.

Easy-to-use equations for the estimation of urine relative saturation in the assessment of risk of recurrence in urinary stones formers

It is a fact that recurrence of urinary stones is a common medical problem. One of the key factors used in determining the risk of urinary stone-formation is the urine relative saturation in the major constituents of lithiasis. Nomograms were developed in the 1970's to estimate the relative saturation of urine. We present here easy-to-use mathematical equations derived from these nomograms. These equations can be integrated directly in the LIS of any laboratories, and can be used as a tool in the treatment and prevention of recurrent stone-formation.

Combination of vitamin E and vitamin C alleviates renal function in hyperoxaluric rats via antioxidant activity.

Hyperoxaluria and oxidative stress are risk factors in calcium oxalate (CaOx) stone formation. Supplement with antioxidant could be effective in prevention of recurrent stone formation. The present study aims to evaluate the protective effects of vitamin E and vitamin C in hyperoxaluric rat. The experiment was performed in rats for 21 days. Rats were divided into 5 groups as follows: control (group 1, n=8), hyperoxaluric rats (group 2, n=8), hyperoxaluric rats with vitamin E supplement (group 3, n=7), hyperoxaluric rats with vitamin C supplement (group 4, n=7) and hyperoxaluric rats with vitamin E and C supplement (group 5, n=7). Hyperoxaluria was induced by feeding hydroxyl L-proline (HLP) 2% w/v dissolved in drinking water. Intraperitoneal 200 mg/kg of vitamin E was given in groups 3 and 5 on days 1, 6, 11 and 16, while 500 mg of vitamin C was injected intravenously in groups 4 and 5 on days 1 and 11. Renal functions and oxidative status were measured. The urinary oxalate excretion was increased in HLP supplement rats, while glomerular filtration rate, proximal water and sodium reabsorption were significantly lower in group 2 compared with a control (P<0.05). Giving antioxidants significantly lower urinary calcium oxalate crystals (P<0.05). Hyperoxaluric rats had higher plasma malondialdehyde (PMDA) and lower urinary total antioxidant status (UTAS), which were alleviated by vitamin E and/or vitamin C supplement. In conclusion, giving combination of vitamin E and vitamin C exerts a protective role against HLP-induced oxalate nephropathy.

Knowledge, attitudes, and practice patterns of recurrent urinary stones prevention in Saudi Arabia.

The purpose of this study is to assess the knowledge, attitudes, and practice patterns of urologists in Saudi Arabia regarding prevention of recurrent stone formation and how much they follow preventive stone disease management guidelines. A questionnaire about knowledge, attitudes, and practice patterns of urologists in Saudi Arabia regarding prevention of recurrent stone formation was used. The survey comprised three domains: knowledge, attitudes, and practice patterns. Data about gender, duration of experience and health care sector were also collected. Individual responses were recorded, tabulated and compared using descriptive statistics. The overall response rate was 38.8%. All respondents were male urologists. Most of them (62, 71.3%) had an experience of 5-20 years in management of stone disease patients and the majority (74, 85.1%) belonged to the governmental health care sector. A total of 51% of the respondents answered in concordance with the best practice guidelines in at least half of the questions and 40% in all of the questions. Overall, practice patterns of 58% of the respondents were in concordance with the best practice guidelines in all the questions except for the question of practices regarding stone analysis. As regards to attitude domain, a total of 58.7% respondents expressed their agreement or strong agreement with the questions. Urologists' knowledge of stone recurrence preventive programs is suboptimal. They do not apply effectively the best stone prevention practice guidelines in their daily practice as well. Efforts to increase knowledge and enforce its application in daily practice are strongly warranted.

Reply

Parallel to the growing rate of obesity mainly because of changes in lifestyle, the prevalence of kidney stone disease has also been found to be progressively increasing in developed Western countries, raising a particular attention regarding the dietary habits and nutritional status of patients with stone formation. Adequate physical activity, normalization of the body mass index, balanced nutrition, and sufficient daily fluid intake are the most crucial factors that are effective in the prevention of recurrent stone formation. Studies have demonstrated that a larger body size in and of itself might also be associated with increased excretion of urinary risk factors, resulting in an increased risk of nephrolithiasis in obese patients. The close correlation between the increasing prevalence of obesity and urolithiasis led us to evaluate and eventually accept obesity as a risk factor for urolithiasis. 1 Siener R. Glatz S. Nicolay C. et al. The role of overweight and obesity in calcium oxalate stone formation. Obes Res. 2004; 12: 106-113 Crossref PubMed Scopus (217) Google Scholar , 2 Powell C.R. Stoller M.L. Schwartz B.F. et al. Impact of body weight on urinary electrolytes in urinary stone formers. Urology. 2000; 55: 825-828 Abstract Full Text Full Text PDF PubMed Scopus (175) Google Scholar

Effect of verapamil on urinary stone-forming risk factors

Prevention of recurrent stone formation will only be possible with careful metabolic evaluation and appropriate management. In this present prospective study, a total of 95 patients with calcium oxalate (CaOx) stone disease were evaluated with respect to the effects of a calcium channel blocking agent (verapamil) therapy on stone-forming risk factors. A total of 95 patients with CaOx urolithiasis were well evaluated for the possible specific effects of verapamil administration on stone-forming risk factors during long-term follow-up. All patients had calcium-containing stones with normal renal morphology and function without any urinary tract infection. The follow-up period ranged from 12 to 36.6 months, with a mean value of 24.4 months. The age of the patients (54 male and 41 female; M/F: 1.31) ranged from 20 to 46 years (mean 34.3 years). On metabolic evaluation all patients had some kind of risk factors and patients were independently randomized into two groups, namely group 1 (n = 49): patients receiving calcium entry blocker, verapamil hydrochloride (isoptin 240 mg KKH tablets, oral t.i.d.); group 2 (n = 46): patients receiving no specific therapy (control patients) that were matched for sex and age. Follow-up results (at least 1 year) with respect to the changes in urinary stone-forming risk factors were recorded in both groups. During long-term follow-up patients undergoing no specific therapy did not show a significant change with respect to the urinary levels of stone-forming risk factors when compared with the others receiving verapamil on a regular basis. In the light of our results as well as the literature data, we believe that the pathophysiological mechanisms underlying the effect of verapamil on stone formation (as a result of enhanced crystal deposition) and on the excretion of the urinary stone-forming risk factors have to be well evaluated in further experimental as well as clinical studies. Although the exact mechanism of action is not clear; we may claim that the limitation of internal calcium shift by these agents may also well effect the tubular process related to oxalate handling which ultimately limits its excretion in urine.

Evaluation of urinary tract calculi in children

Renal stone disease remains a significant health problem in the adult population, with the incidence of urolithiasis estimated to be as high as 12%.1 The true incidence in childhood is...

The effect of long-term alkali therapy for recurrent calcium stone patients with distal renal tubular acidosis

Alkali therapy is widely accepted as a treatment for recurrent calcium stone patients with distal renal tubular acidosis (dRTA). Nine patients, five with complete and four with incomplete type of dRTA, were treated with alkali agents for more than three years; an average period of 10.8 years. In five patients, new stone formation and stone growth were completely prevented by this treatment. Among the four failed cases, three did not take enough alkali agents (in spite of our medication), and the other had recurrent urinary tract infection resulting in infectious stone formation. In conclusion, the long-term efficacy of alkali therapy for prevention of recurrent stone formation with dRTA is confirmed when the patient takes enough alkali agents and the urinary tract infection is well controlled.

Prevention of recurrent stone formation: Long time results under treatment based on an extended metabolic investigation

Prevention of recurrent stone formation: Long time results under treatment based on an extended metabolic investigation

Urinary calculous disease--a saga of urological field in Japan

The management of urinary calculous disease has been a treasured place also in urological history of Japan. Recently, innovatory procedures for stone removal have been introduced and the excellent advances of Endourology and ESWL (extracorporeal shock wave lithotripsy) revolutionized the surgical treatment of renal calculous disease. However, some thoughtful members of urologists have been afraid that the majority of the urological surgeons might believe if they have already completed the treatment of urolithiasis and succeeded the resolution on the patients with renal calculous disease. Now, I will write a saga of the investigations of this interesting and still important subject in the urological field of Japan, looking back my own way who have been interested in urolithiasis treatment and also its prophylaxis. The goal of the treatment for urinary calculous patients should be the prevention of recurrent stone formation because the surgical treatment is only the removal of existing stones, even recent advance of innovatory procedures could confer the less invasive benefits on urinary calculous patients. Some selective medical treatment programs have been introduced and emerged therapeutic importance to the prevention of renal stone formation and more will have elaborated in the future. Several investigations on the difficult mechanisms of stone formation have been also vigorously accomplishing by some urologists in Japan. I hope that I would anticipate what is to come on the entire solution of the precise mechanism of stone formation and ultimate control of urolithiasis by successional young urologic investigators in near future.