Urinary stone composition in North-East Thailand

Stones removed from 120 adults and 22 children were analysed for chemical composition. Calcium oxalate was the main component of both adult (49%) and childhood (44%) stones. Calcium stones formed the major type in adults and were slightly more common in males, whereas urate/uric acid stones were predominant in children and were more common in girls. In adults, the stones were usually found in the upper urinary tract (UUT) and were mainly of calcium type (72%), while all three types were found in almost equal amounts in the lower urinary tract (LUT). Magnesium ammonium phosphate and urate/uric acid were the stones found mainly in the upper and lower urinary tracts respectively of children.     

Urolithiasis in Okinawa, Japan: A relatively high prevalence of uric acid stones

AIM: The aim of the present study was to investigate the composition of urinary tract stones in patients from Okinawa, the most southern island group of Japan. METHODS: The study was conducted by 12 hospitals in Okinawa. A total of 1816 urinary tract calculi were obtained from 1816 patients (1323 males; 493 females). The patients had a mean age of 53 +/- 15.3 years (mean +/- SD). The calculi were examined to determine their chemical composition. Stone samples were analyzed by computed infrared spectrophotometer. RESULTS: Pure stones comprised 58.4% of the total, with calcium oxalate stones accounting for 40% (21% monohydrate [whewellite]; 6.6% dihydrate [weddellite]; and 12.4% combined monohydrate and dihydrate stones), uric acid/urate stones for 9.6%, calcium phosphate stones for 5.1%, and struvite stones for 3.7%. The other 41.6% of the stones consisted of calcium oxalate mixed with other components. The male-to-female ratio was 2.7:1. CONCLUSION: In our series, calcium oxalate stones accounted for 81.6% of the urinary tract calculi, while uric acid/urate stones accounted for 15.8%. Uric acid stones, predominantly the anhydrous and/or dihydrate forms, showed a relatively high prevalence. Calcium oxalate stones, predominantly in the form of whewellite, showed a high prevalence among pure calculi; while the predominant combinations among mixed calculi were weddellite + calcium phosphate and whewellite + uric acid/urate.     

延安地区泌尿系结石成分分析的研究

目的利用红外光谱法测定延安大学附属医院泌尿外科手术获得的泌尿系结石成分,探讨延安地区泌尿系结石成分与年龄、性别等关系,比较上、下尿路结石成分特点,分析延安地区泌尿系结石发生的流行病学情况,为临床制定有效的个体化治疗及预防措施提供参考依据。方法收集2013年1月至2017年1月在延安大学附属医院泌尿外科治疗1984例尿路结石患者的年龄、性别、结石部位等临床资料,对比分析延安地区泌尿系结石在不同年龄、不同性别、不同解剖部位的分布特点。结果在1984例泌尿系结石的患者中,按每10岁年龄大小分组排序,统计各年龄阶段泌尿系结石发病情况,男性患者有1346例,女性患者有638例,男性年龄(50.23±14.48)岁,女性年龄(47.87±14.51)岁,男、女患者比例约2.11∶1。在66~75岁年龄段,尿路结石发病率性别差异具有统计学意义(P<0.05)。结石成分以混合性结石为主,以混合性结石为主,共1582例,占79.76%。其中1665例(83.92%)为上尿路结石,上、下尿路结石的比例为5.22∶1,其余为肾结石合并膀胱结石。上尿路结石中男性1062例,女性603例,男女比例为1.76∶1;下尿路结石中男性284例,女性35例,男女比例为8.11∶1。青壮年(年龄≤45岁)泌尿系结石患者草酸钙为主结石、感染性结石多见;中老年(年龄>45岁)泌尿系结石者草酸钙为主结石、尿酸类结石多见。感染性结石患者性别差异具有统计学意义(P<0.05)。结论在延安地区男性较女性更容易患泌尿系结石。同时,不同年龄段结石构成成分具有差异。对于年龄≤45岁患者,主要以草酸钙为主结石、感染性结石多见,这与结石整体发病率基本一致;而对于年龄>45岁患者,主要以草酸钙为主结石、尿酸性结石多见。表明对于不同年龄段的结石患者,可以根据上述结果在结石的预防和治疗上综合考量,给予明确而更加合理的治疗。     

Epidemiological characteristics of urolithiasis in Okhotsk coast area in Hokkaido

An epidemiological study of 422 stone-formers who visited our hospital from 1997 to 2001 was conducted. The mean annual prevalence and incidence of both upper and lower urinary tract stones were higher than what was found in a nationwide urolithiasis survey carried out in Japan in 1995. The incidence of upper and lower urinary tract stones was 90.8% and 9.2%, respectively. The frequency of lower urinary tract stones was higher than that found in the previously mentioned nationwide study. The male-to-female ratio of upper and lower urinary tract stones was 1.68:1 and 2.25:1, respectively. The frequency in females was higher in this study than that found in the nationwide survey. The peak age for incidence of upper urinary tract stones is 50s in males and females. In the treatment of upper urinary tract stones, ureteroscopic lithotripsy was carried out more often than shock wave lithotripsy (SWL), because our hospital had no SWL device. Many endoscopic lithotripsy procedures were performed to treat stones located in the lower urinary tract. Of the upper urinary tract stones 83.7% were composed of calcium, the incidence of uric acid stones was high (6.6%), whereas the incidence of infectious stones was low (1.9%). For lower urinary tract stones, the frequency of infectious stones was high (52.6%). In the present study, the epidemiological features were as follows: high annual prevalence and incidence, high frequency of lower urinary tract stones, high frequency in females, many endoscopic treatment procedures and high frequency of uric acid stones in the upper urinary tract.     

泌尿系结石成分450例分析

目的分析泌尿系结石患者的发病年龄及性别特点,探讨结石部位与患者年龄及性别的关系,根据结石不同成分采用不同预防措施。方法应用化学分析法对450例尿路结石做成分分析,结合临床资料,对尿路结石患者发病年龄、性别、结石部位及结石成分做对比分析。姑杲男性患者321例,高发年龄21～60岁;女性129例,高发年龄41～60岁;男性发病率是女性的2．49倍。发病部位肾脏结石319例（70．8％）,输尿管结石115例（25．6％）,膀胱结石16例（3．6％）;单一成分结石275例（61％）,其中单纯草酸钙结石260例（57．7％）,两种及以上混合成分结石175例（39．0％）。结论尿路结石的发病率及发病年龄存在着明显的性别差异;尿路结石发病部位主要为上尿路结石;单一成分结石以草酸钙为主,约40％的尿路结石为两种及以上混合成分结石。     

南充地区泌尿系结石成分分析及其与国内各地结石成分的差异

目的 研究四川南充地区尿石症患者尿石成分,并与国内其他地区进行比较,为临床预防、治疗提供依据.方法 采用结石红外光谱自动分析系统对2011年3月至2012年9月255例南充市尿路结石患者结石标本进行成分测定,结合临床资料进行研究,并收集国内其他地区报道的结石成分文献进行分析研究.结果 南充地区尿路结石以草酸钙（91.37％）、碳酸磷灰石（62.35％）为主要成分,结石患者男女比为1.90∶1,上尿路结石占87.84％（224/255）,下尿路结石占12.16％（31/255）,上、下尿路结石比为7.23∶1,上尿路结石患者男女比例为1.60：1,下尿路结石患者男女比例为14.5∶1.结论南充地区泌尿系结石成分和国内其他地区结石成分无明显差异,但下尿路结石患者男性所占比例明显高于其他地区.     

Bacteriology of upper urinary tract stones

Extensive cultures of stones and urine were performed in 215 patients who underwent an operation for upper urinary tract calculi. Microorganisms could be cultured from the stone in 1 of every 3 patients. Despite the extended culture technique urease-producing microorganisms could be cultured from the stone in only 48% of the patients with calculi that contained magnesium ammonium phosphate. This finding suggests that an infection with urease-producing microorganisms is not obligatory for the formation of this type of stone. Of the patients with calcium oxalate phosphate stones 32% had positive stone cultures, which distinguished them from patients with pure calcium oxalate stones, only 8% of whom had a positive stone culture (p less than 0.001).     

Metabolic and demographic characteristics of children with urolithiasis in Western Turkey

Pediatric urolithiasis is an endemic disease in Turkey. We evaluated the clinical, radiological and metabolic features of children with urolithiasis in Western Turkey. We retrospectively reviewed the records of 85 children with urolithiasis who were followed-up between 2004 and 2010 in Pediatric Nephrology Department of Celal Bayar University, Manisa. The male/female ratio was 1.23/1. The mean age at diagnosis was 66.1 months (range 3–210 months). Family history of urolithiasis was found in 58 (68.2%) patients. 23 (27%) patients were born from consanguineous marriages. Stones were located in the upper urinary tract in 79 (92.9%) patients. In 66 (77.6%) patients, stones were single-sided and 41 (48.2%) patients had multiple stones. Calcium oxalate stones were the most common one among patients in whom stone analysis was performed (78.5%). Hypocitraturia was the most commonly detected urinary metabolic risk factor. In patients who were under 12 months of age at diagnosis, hypercalciuria was the most commonly seen urinary metabolic risk factor. At the end of follow-up period, 24 patients became free of stone disease and 4 patients had recurrence. In conclusion, metabolic abnormalities are common in pediatric stone patients and are strongly associated with recurrence. Considering that urolithiasis in children is an important risk factor for renal failure, early diagnosis, detailed metabolic evaluation and implementing appropriate treatment and follow-up protocols may prevent recurrence and renal damage.     

Physicochemical metabolic characteristics for calcium oxalate stone formation in patients with gouty diathesis

PURPOSE: We determined why calcium oxalate stones instead of uric acid stones form in some patients with gouty diathesis. MATERIALS AND METHODS: Gouty diathesis was diagnosed from absence of secondary causes of uric acid stones or low urinary pH, and reduced fractional excretion of urate with discriminant score of the relationship between urinary pH and fractional excretion of urate less than 80. From the stone registry 163 patients with gouty diathesis were identified, including 62 with uric acid stones (GD + UA) and 101 patients with calcium oxalate stones (GD + Ca). Metabolic data and 24-hour urinary chemistry study were compared between the 2 groups. RESULTS: Compared with GD + UA, GD + Ca had significantly greater urinary calcium (196 +/- 96 mg per day vs 162 +/- 82 mg per day, p <0.05) and significantly lower urinary citrate (430 +/- 228 vs 519 +/- 288 mg per day, p <0.05), resulting in higher urinary saturation of calcium oxalate. Both groups had low urinary pH (less than 5.5) and high urinary undissociated uric acid (greater than 100 mg/dl). Urinary calcium post-oral calcium load was significantly higher in GD + Ca than in GD + UA (0.227 vs 0.168 mg/dl glomerular filtrate, p <0.001). CONCLUSIONS: Calcium oxalate stones may form in some patients with gouty diathesis due to increased urinary excretion of calcium and reduced excretion of citrate. Relative hypercalciuria in GD + Ca may be due to intestinal hyperabsorption of calcium.     

广东南海地区泌尿系结石患者结石成分分析(附986例报告)

【摘要】 目的 应用红外光谱法分析广东南海地区泌尿系结石患者的结石,为临床个性化防治泌尿系结石及复发提供理论依据。方法 通过自然排出、碎石后排出或手术取出获得结石样本986例,并应用红外光谱法对其行结石成分分析。结果 泌尿系结石患者男女比例为1.34∶1,51岁~60岁年龄阶段患者所占比例最高,上尿路结石发病人数明显多于下尿路结石,比例达9.49∶1。定性分析共检测出一水草酸钙、二水草酸钙、碳酸磷灰石、无水尿酸、六水磷酸镁铵和胱氨酸6种化学成分。混合成分结石647例,占总人数的65.6%;含钙结石853例,占86.51%。草酸钙检出率最高,占77.38%,其次是碳酸磷灰石(5.27%)和尿酸(13.29%)成分。结论 采用红外光谱法分析泌尿系结石成分,对于了解结石成因、预防结石形成和复发具有重要的意义。     

Urolithiasis in Jordanian children. A report of 52 cases

Fifty-two children with urinary calculi seen between 1975 and 1986 were reviewed. Males dominated the series. The age distribution ranged from 10 months to 14 years (mean 7.2 years); 71% presented after school age. Most patients had upper tract stones. The main presenting symptoms were abdominal pain, infection and haematuria. The causative factors or co-factors were infection, malformations and urodynamic abnormalities. Metabolic disorders were rare. Calcium oxalate and uric acid stones were found most often. Surgical management was required in 88% of patients and only 3.8% had a recurrence. Presenting symptoms are variable and so a high index of suspicion is required for diagnosis.     

湖北天门地区泌尿系结石成分及特征分析

目的分析湖北省天门地区泌尿系结石患者的结石成分成分及特征。方法 泌尿系结石患者516例,采用红外光谱自动分析系统对患者结石标本的成分进行分析,并比较不同性别、年龄、结石部位的泌尿系结石的成分特征。结果天门地区结石成分以草酸钙(83.9%)、碳酸磷灰石(56.2%)为主要成分,结石患者男女比例为1.7:1,其中上尿路结石患者男女比例为1.34:1,下尿路结石患者男女为24.3:1。结石发病年龄高峰在40~70岁(占比83.1%)之间,其中50~60岁为最高(占比33.7%)。男女结石成分有显著性差异(P0.01)。结论天门地区泌尿系结石成分以草酸钙及碳酸磷灰石为主,男女性别之间的结石成分差异明显。     

Spectrum of stone composition: structural analysis of 1050 upper urinary tract calculi from northern India

BACKGROUND: The purpose of the present paper was to study the spectrum of stone composition of upper urinary tract calculi by X-ray diffraction crystallography technique, in patients managed at All India Institute of Medical Sciences. METHODS: Between 30 April 1998 and 31 March 2003, a total of 1050 urinary calculi (900 renal, 150 ureteric) were analyzed. The stone fragments were collected after extracorporeal shock-wave lithotripsy, or retrieval by endoscopic (percutaneous nephrolithotomy, ureterorenoscopy), laparoscopic and various open surgical procedures. The structural analysis of the stones was done using X-ray diffraction crystallography. RESULTS: Four types of primary and three secondary X-ray diffraction patterns were obtained. The primary patterns were as follows. Pattern A, well organized crystalline structure; pattern B, moderately organized crystalline structure; pattern C, poorly organized crystalline structure; pattern D, very poorly organized crystalline structure. The three secondary patterns mainly highlighted the mixed variety of stones. These patterns were further analyzed and compared with standard X-ray diffraction (powder) photographs. Of the 1050 stones analyzed, 977 (93.04%) were calcium oxalate stones, out of which 80% were calcium oxalate monohydrate (COM) and 20% were calcium oxalate dihydrate (COD). Fifteen were struvite (1.42%) and 19 were apatite (1.80%). Ten were uric acid stones (0.95%) and the remaining 29 (2.76%) were mixed stones (COM + COD and calcium oxalate + uric acid, calcium oxalate + calcium phosphate, and calcium phosphate + magnesium ammonium phosphate). A total of 89.98% of staghorn stones were made of oxalates (COM/+COD) and only 4.02% were struvite. CONCLUSION: Urinary stone disease in the Indian population is different from that in Western countries, with a larger percentage of patients having calcium oxalate stones, predominantly COM. Also, the majority of staghorn stones (89.98%) were made of oxalates.     

Influences of bacteria within stones on ESWL treatment]

On 26 patients with upper urinary stones treated by extracorporeal shock wave lithotripsy (ESWL), the influences of the bacteria within the stones on the inflammatory complications, especially on urinary tract infection, after the ESWL treatment, were studied. The constituents of the stones obtained from these 26 patients consisted of the mixed stone of calcium oxalate and calcium phosphate (10 patients), calcium oxalate alone (2 patients), calcium phosphate alone (1 patient) and uric acid (1 patient). Of these 26 stones including no infection stones such as struvite and carbonate apatite, 5 stones (19.2%) had bacteria within the stone. Although no patients had severe inflammatory complications after ESWL treatments, the fact that the patient group having bacteria within the stones had a significantly elevated body temperature at one day after ESWL treatment compared to that on the preoperative day (P < 0.01) suggests that we should take into consideration the bacteria within non-infection stones as one of the risk factors of inflammatory complications after ESWL treatment.     

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.     

Pattern of urolithiasis in Brooklyn, New York

Crystallographic analysis of 261 upper urinary tract calculi from patients in Brooklyn is presented. Calcium oxalate, uric acid, and struvite stones predominate. We could not confirm the hypothesis that uric acid forms a nidus in calcium oxalate urolithiasis in spite of a percentage of uric acid calculi more than twice the national average.     

The aetiological and clinical pattern of childhood urolithiasis in Saudi Arabia

The clinical and aetiological pattern in 85 stone-forming children presenting to an integrated nephrourological service in Riyadh is reviewed. All patients were below the age of 15 years, the male to female ratio being 2∶1. Only 2 children presented with bladder calculi. The remaining all had upper tract stone and, in 12 cases, these were bilateral. Of 34 calculi recovered for analysis, one-third was predominantly calcium oxalate and a further third was composed of uric acid or urate. Four patients had cystine stones and the remaining 7 presented mixed calcium stones, 6 (17.6%) being struvite and infection-related. Of the 85 patients 55 were treated successfully with extracorporeal shock wave lithotripsy, 16 underwent surgery and 7 had their stones removed by endourological procedures. In the remaining 7 children, stones dissolved or were passed spontaneously during medical therapy. Nine children (10.6%) showed a primary metabolic defect leading to their stone formation, 10 (11.8%) had a predisposing anatomical anomaly and 15 (17.6%) presented with urinary tract infection. Of the remaining 51 patients (60%) with idiopathic disease, 6 showed hypercalciuria on investigation and 2 children may have formed their stones due to prolonged recumbency.     

The clinical study of 794 patients with an upper urinary tract stone analyzed by infrared spectroscopy

During the 48-year period from January, 1938 to December, 1985, upper urinary tract stones obtained from 794 patients were analyzed by infrared spectroscopy in our Department. Their clinical manifestations were studied, mainly in relation to stone composition. The ratio of males to females was 3.0 to 1. In recent years, the incidence of females tended to increase. In the age distribution, twenties were most frequent followed by thirties together with fourties before 1965, but after 1966, the thirties were most frequent, and fourties and fifties increased. The composition of 794 stones was as follows. The most frequent type was calcium oxalate combined with calcium phosphate (43.1%), followed by calcium oxalate (39.8%) and calcium phosphate (9.6%). Magnesium ammonium phosphate stones were found in 1.6% and uric acid stones in 2.9%. Calcium oxalate stones, uric acid stones and oxalate-containing stones were found more frequently in males than in females. On the other hand, magnesium ammonium phosphate stones, calcium phosphate stones and phosphate-containing stones were found less frequently in males than in females. There was a high occurrence of calcium phosphate stones and uric acid stones in patients older than 60 years old. The occurrence of calcium oxalate stones and uric acid stones increased and that of phosphate-containing stones decreased after 1966. Most of the recurrent stones revealed the same or similar composition as the initial stones.     

Annual changes of the incidence and clinical characteristics of magnesium ammonium phosphate urinary stones

BACKGROUND: Magnesium ammonium phosphate (MAP) urinary stones account for the majority of staghorn stones and frequently cause a non-functioning kidney. In the present study, we examined the annual changes of the number and clinical characteristics of MAP stones. METHODS: The annual incidence of MAP stones was investigated in 2619 patients with urinary stones in whom composition of the stone was analysed at Chiba University Hospital between 1964 and 1999. In addition, the annual number of patients with MAP stones was examined at Funabashi Clinic. In a total of 644 patients with MAP stones, age and sex of the patients, location and size of the MAP stones, urinary cultures and etiological factors were analysed. RESULTS: The number of MAP stones in the lower urinary tract was relatively constant. In contrast, MAP stones in the upper urinary tract had dramatically decreased since 1989, resulting in an increase in the rate of MAP stones in the lower urinary tract. Age distribution of the MAP stone patients ranged from 10 years to > 80 years, with the majority aged 30-60 years. The proportion of larger MAP stones in the upper urinary tract increased. There was no significant difference in prevalence of urine cultures. Among etiological factors for MAP stones, difficulty on urination tended to be common in recent years. CONCLUSION: The number of MAP stones, especially in upper urinary tract, has been decreasing during the last decade. At present, treatment of urinary tract obstruction seems important for the management of MAP stones in lower urinary tract.     

Flexible ureterorenoscopy for the treatment of refractory upper urinary tract stones.

OBJECTIVE: To report our experience of using flexible ureterorenoscopy for upper urinary tract stones. PATIENTS AND METHODS: Thirty-seven patients (13 females, 24 males, mean age 48 years, range 10-76) with upper urinary tract stones not responding to other treatments had their residual symptomatic stones treated through a 9.3 F flexible ureterorenoscope. Electrohydraulic lithotripsy (EHL) was used to fragment the stones and a basket or a grasper used to retrieve the fragments. RESULTS: Twenty-three patients were completely freed of stone and a further five had asymptomatic residual fragments of < 5 mm. Of 15 patients with ureteric stones, 14 were rendered stone-free at the end of the procedure and 14 of the 22 patients with kidney stones were treated successfully; 80% of the lower calyceal stones were treated successfully and a firm decision was possible on the further management of the remaining stones. There were no major complications. CONCLUSION: Flexible ureterorenoscopy should be considered in patients with symptomatic upper ureteric or renal stones refractory to other treatments, but the instrumentation is expensive and delicate, and its use should be reserved for such cases.