Indinavir urolithiasis

Indinavir sulfate is a protease inhibitor that has been found to be extremely effective in increasing CD4+ cell counts and in decreasing HIV-RNA titers in patients with HIV and AIDS. However, patients receiving indinavir also have been noted to have a significant risk for developing urolithiasis. Published reports of indinavir urolithiasis estimate its incidence at between 4 and 13%. Indinavir has a high urinary excretion with poor solubility in a physiologic pH solution. Consequently, patients develop urinary stones that are principally composed of indinavir or of a mixture of indinavir and other substances, such as calcium oxalate. Similar to other forms of urolithiasis, acute flank pain and hematuria are the typical symptoms of indinavir urolithiasis. Indinavir urolithiasis is unique in that computed tomography, which was once thought to be efficacious in identifying all urinary calculi, is not useful in imaging stones that are composed of pure indinavir. Indinavir urolithiasis generally responds to a conservative regimen of hydration, pain control, and the temporary discontinuation of the medication. Only a minority of patients need surgical intervention. Approximately 10% of patients ultimately need to discontinue indinavir therapy altogether. Indinavir is an antiviral agent that has a significant role in the treatment of AIDS. Although urolithiasis is a significant side effect of indinavir use, limiting its clinical application is not the answer. Rather, physicians need to know more about indinavir urolithiasis to help their patients cope with its potential complications.     

Clinical patterns of paediatric urolithiasis

A series of 270 paediatric stone patients was studied retrospectively according to the clinical pattern of urolithiasis (age and sex, stone location, stone analysis, recurrence rate) and aetiology of stone disease (infection, anatomical, metabolic or idiopathic). Infection stones occurred earliest and more commonly in males and were usually upper tract struvite calculi related to Proteus infection. Anatomical stones were most commonly associated with pelviureteric junction (PUJ) obstruction and had a high recurrence rate, despite surgical correction of obstruction. Idiopathic stones most resembled those found in adult urolithiasis by virtue of occurring latest, being sited in the ureter more often and being more frequently composed of calcium oxalate. Metabolic stones were most frequently calcium phosphate or cystine and virtually all were renal. They comprised the smallest group but had the highest recurrence rate.     

上尿路结石复发原因分析及其治疗(附42例报告)

目的:探讨泌尿系结石复发的原因及其处理措施。方法:回顾性分析2005年1月～2010年5月在我院接受治疗的42例上尿路复发结石患者临床资料,并对其尿石成分进行分析,对血、尿理化指标及代谢指标进行检测。结果:术后复发结石成分中,与原发结石成分相同者34例;与原发结石成分不同者8例,其中1例为尿流改道术后(草酸钙结石变为尿酸结石),1例为ESWL术后(草酸钙结石变为尿酸结石),3例为开放取石术后(草酸钙结石变为感染结石及尿酸结石),2例为输尿管碎石取石术后(尿酸结石变为感染结石)。在血、尿理化检测中,糖尿病8例,尿路感染7例,肥胖6例,甲状旁腺机能亢进3例。结论:根据复发性尿路结石的临床特点及诱发因素,采取针对性措施,选择合理的治疗方式,可以提高治疗效果。     

Urolithiasis and the protease inhibitor indinavir

OBJECTIVE: To evaluate specific urological abnormalities in patients treated with the protease inhibitor indinavir. METHODS: A series of 155 consecutive human immunodeficiency virus-positive patients were treated with indinavir 800 mg p.o. three times a day. Of these, 14 (9%) treated for 1-321 (average 110) days experienced severe flank pain and were subjected to clinical and laboratory examinations. RESULTS: Abdominal X-ray was consistently negative for stones. Ultrasonography showed upper-tract dilatation in 12 patients. Intravenous urography showed obstruction above a radiolucent obstacle in 7 patients; in 2 cases, there was a marked delay in urine excretion on the obstructed side. The mean urine pH was 6. Urine culture was negative. Serum uric acid, phosphorus, and calcium levels were normal. In 8 patients there was slight renal insufficiency, and 4 patients required ureteral stenting. In all cases, hyperhydration and oral analgesia led to a favorable outcome. In 3 patients, chemical analysis of the stone demonstrated monohydrate indinavir crystals. CONCLUSIONS: In our experience, indinavir therapy is associated with urolithiasis in 9% of the cases. Hydration, analgesia, and acidification of the urine usually lead to a favorable clinical outcome. Prophylactic hydration and acidification of the urine are extremely important.     

SEQUENTIAL ANALYSIS OF RECURRENT CALCIUM CALCULI BY INFRARED SPECTROSCOPY

Background: While the incidence of calcium urolithiasis increases, the precise mechanism of calcium oxalate stone formation is still controversial. Is the composition of a recurrent calcium oxalate stones always the same as previous ones? There are few reports that specifically address the question by study of sequential changes of the composition of recurrent calcium calculi. Method: From our medical records 70 patients with a history of two or more recurrent episodes of calcium oxalate stone disease were selected and the analyses of 190 stones were reviewed. Infrared spectroscopic analysis was done using a Perkin Elmer 1740 spectrophotometer. Results: Calcium oxalate monohydrate were detected in 63 stones, calcium oxalate dihydrate in 12, calcium oxalate monohydrate mixed with dihydrate in 28, calcium oxalate monohydrate mixed with calcium phosphate in 30, calcium oxalate dihydrate mixed with calcium phosphate in 20, calcium oxalate monohydrate mixed with dihydrate and calcium phosphate in 20, calcium oxalate monohydrate mixed with dihydrate and calcium phosphate in 37. Alterations of stone components during follow-up were found in 43 stones from 40 patients. The shift of a main composition from calcium oxalate monohydrate to calcium oxalate dihydrate was found in 24 stones and vice versa in 19 stones. Conclusions: Sequential changes of the compositions of recurrent calcium calculi are highly likely to occur with time in individual recurrent calcium stone formers. Calcium oxalate monohydrate was a most common component of the studied recurrent calcium stones.     

INDINAVIR UROLITHIASIS: AN EMERGING CAUSE OF RENAL COLIC IN PATIENTS WITH HUMAN IMMUNODEFICIENCY VIRUS

PURPOSE: We evaluate the clinical, diagnostic and radiographic findings in patients on indinavir therapy who presented with renal colic, and propose appropriate treatment options for indinavir urolithiasis. MATERIALS AND METHODS: A total of 16 patients positive for human immunodeficiency virus on indinavir were evaluated for 18 episodes of severe renal colic requiring hospitalization. Laboratory evaluation was performed in all patients followed by an imaging study. Conservative treatment included intravenous hydration, narcotic analgesics and temporary cessation of indinavir. Intervention was elected only in patients with persistent fever or intractable pain. A month after hospital discharge an excretory urogram and metabolic stone evaluation were performed. Mean followup was 9.3 months and 2 patients had recurrent symptoms. RESULTS: All patients presented with nausea or vomiting and hematuria. Imaging studies confirmed obstruction in all patients with 13 radiolucent (indinavir) and 3 radiopaque (calcium oxalate) stones. Patients with radiolucent and radiopaque stones demonstrated significant differences in urinary pH (p = 0.002) and serum creatinine (p = 0.03). Conservative therapy was successful in 11 patients (68.8%) within 48 hours and 4 patients (25%) with radiolucent calculi required endoscopic stenting for persistent fever. Metabolic stone evaluation demonstrated significant hypocitruria (less than 50 mg./24 hours) in all patients with radiolucent calculi. CONCLUSIONS: The urologist should be familiar with this growing cause of renal colic in patients on indinavir therapy. Pure indinavir stones are radiolucent and have a soft, gelatinous endoscopic appearance. Conservative treatment is successful in most patients and if intervention is deemed medically necessary, endoscopic stent placement should be the procedure of choice.     

Urolithiasis in adults with congenital megaureter

The primary presentation of congenital megaureter in adults is rare. Development of urolithiasis may lead to this unusual underlying diagnosis. Urinary tract stones can form either within the dilated ureteral segment or in a part of the upper urinary tract proximal to the abnormal ureteral segment. We report two cases of nephrolithiasis that occurred in adults found to have segmental megaureter. The first case is that of a 58-year-old man who presented with left lower quadrant pain. Computed tomography scan revealed a 2-cm stone in the distal left ureter within an area of isolated segmental distal ureteral dilation. The second case is a 48-year-old man who developed recurrent renal urolithiasis associated with isolated distal megaureter.Although a rare condition in adults, congenital megaureter may present when kidney stones develop as a result of the ureteral abnormality. Typically, stones will develop within the dilated segment of ureter. Atypically, stones may develop away from the site of the underlying abnormality. Congenital megaureter is a diagnosis that urologists and radiologists need to consider in the setting of isolated distal ureteral dilation, as the diagnosis of adult megaureter may require more involved surgical measures to prevent recurrence of adverse symptoms.     

Effect of oxalate on the growth of renal tubular epithelial cells

PURPOSE: Until recently, oxalate was considered merely as a major component of calcium oxalate stones, forming crystals in the lumen of the renal tubules. However, new evidence suggests that oxalate is not only a major constituent of calcium oxalate stones but also has effect on renal tubular epithelial cells, affecting the pathogenesis of nephrolithiasis. We tried to elucidate the effect of oxalate on the growth of renal tubular epithelial cells of different species and locations and also to interpret the possible role of the oxalate in the pathogenesis of urolithiasis. MATERIALS AND METHODS: Porcine proximal renal tubular epithelial cells (LLC-PK1) and canine distal renal tubular epithelial cells (MDCK) were incubated with different concentrations of oxalate, and the effect of oxalate on the growth of the cells was assessed by methylthiazoletetrazolium assay. RESULTS: Growth of the renal tubular epithelial cells was inhibited with increasing concentrations of oxalate in both proximal and distal lines. CONCLUSION: Oxalate may cause stone formation by affecting the growth of renal tubular epithelial cells as well as by providing a constituent of calcium oxalate stones.     

Preliminary experience with the pulsed dye laser for treatment of urolithiasis

We report our initial experience using the pulsed dye laser in 26 patients with urolithiasis. The patients ranged in age from 27 to 82 years; 11 patients were female and 15 were male. Of the 26 patients, 4 stones were in the kidney, 21 were in the ureter, and one was in the bladder. Surgical time ranged from 32 to 130 minutes. All patients were treated under spinal or general anesthesia. The size of ureteral stones ranged from 0.2 to 1.5 cm, and the renal stones 3.0 to 4.0 cm. Chemical analysis of the stones was not available on all patients, but when available, chemical analysis revealed the stones to be calcium monohydrate, calcium dihydrate, or struvite. The use of the Candela miniscope in 11 patients permitted access without ureteral dilation. In 19 patients, ureteral stents were placed. One patient suffered a ureteral perforation. Success was defined as adequate disintegration of the stone for passage of the fragments without the necessity of a secondary procedure. Using this criterion, 22 of 26 patients were successfully treated for an overall success rate of 85%.     

A simple ion — chromotographic method for determination of urinary oxalate

Summary A simple and rapid technique for the determination of oxalate in urine by ion chromatography has been described. Although there is difficulty in separating the oxalate peak from the sulfate peak on the conductivity chromatogram of unprocessed urine, it is possible to eliminate the sulfate peak by the addition of barium chloride to the urine. Using this technique, the author has estimated the urinary oxalate in 33 urolithiasis patients and in 40 non-urolithiasis patients. The means of 50 urinary oxalate determinations in 33 urolithiasis patients and of 42 urinary oxalate determinations in 40 non-urolithiasis patients were 21.5±11.4 and 19.5±13.0 mg/gCr, respectively. Of the 33 urolithiasis patients, 17 were calcium stone formers and 6 were non-calcium stone formers whose stones had been analyzed by infrared spectrometry, and the mean urinary oxalate values were 19.4±6.9 and 21.3±8.2 mg/gCr, respectively. The urinary oxalate was significantly higher in children under the age of 10 years.     

Comparative study of extracorporeal shock wave lithotripsy outcomes for proximal and distal ureteric stones

Objective To assess the efficacy of extracorporeal shock wave lithotripsy (ESWL) monotherapy for isolated proximal ureteral calculi and compare it to that for isolated distal calculi. Patient and methods We treated 68 patients with isolated ureteral stones using MPL 9000. Stones were located in the proximal and distal ureters in 44 and 24 patients, respectively. Patients were stratified according to stone burden and degree of obstruction. Data of all patients were prospectively collected for stone burden, stone localization, number of sessions, number of shock waves, stone-free rates (SFRs), complications, re-treatment rates and auxiliary procedures. Outcomes regarding ureteral localization were compared. Results The overall SFR was 85.3% with a 41.2% re-treatment and 17.6% auxiliary procedure rate. The mean number of shock waves applied for each stone was not different among the two ureteral locations. The SFRs were 86.3% and 79.1% for proximal and distal ureteral stones, respectively (P = 0.17). For the group with stones <100 mm2, the SFR was 85.4% and 89.5% for the proximal and distal ureter, respectively. Although the degree of obstruction did not affect SFR of the entire group (P = 0.12) and the proximal ureter group (P = 0.96), it adversely affected SFR in the distal ureter (P = 0.017). Conclusions ESWL outcomes for the ureteral calculi support the use of lithotripsy particularly for stones <100 mm2. Treatment efficacy was not significantly different among stones localized in proximal and distal ureters. Degree of obstruction did not affect the ESWL outcomes in the proximal ureter, but it adversely affected SFR in the distal ureter.     

What radiation exposure can a patient expect during a single stone episode?

PURPOSE: There is increasing concern about the risks of radiation exposure with the advent of new, more complex imaging modalities. For example, computed tomography (CT), with its obvious advantages, is being more commonly used in the investigation of acute flank pain. The likely radiation exposure a patient can expect during a single complete urinary stone episode was studied. PATIENTS AND METHODS: The hospital records of 60 consecutive unselected patients who had become or were rendered stone-free were studied. The effective radiation doses in milliSieverts (mSV) associated with diagnostic imaging modalities such as intravenous urogram studies and CT scans were calculated for St. George's Hospital. By combining these with the published effective doses for interventional examinations, the total effective dose over an entire stone episode was derived. RESULTS: There were a total of 60 patients with 68 stones (15 renal, 9 in the upper, 12 in the middle, and 32 in the lower ureter), with a median stone burden of 4 mm. Thirty-two patients had procedures performed, including extracorporeal shockwave lithotripsy SWL. Total effective doses ranged from 1.18 to 37.66 mSv (median 5.3 mSv; 95% CI of the median 4.13, 7.61). Renal and proximal ureteral stones resulted in the highest radiation exposures. CONCLUSION: In this study the median radiation dose per stone episode was calculated at 5.3 mSv, with higher doses in those with renal stones and those who required CT scans and other interventions. Monitoring and reduction of radiation exposure is advised for all patients presenting with urolithiasis.     

Studies on urolithiasis. The histochemistry of the kidney tissues and stones from patients with urolithiasis

In this study, 17 kidney tissue specimens and 29 renal stones were obtained from patients with urolithiasis. Control kidney specimens were dissected from 7 individuals not suffering from urolithiasis. The tissue specimens were fixed with 1% cetylpiridinium chloride (CPC) in 10% formalin (for 24 hours at room temperature). Then the kidney tissue specimens were embedded in paraffin and stained with hematoxylin-eosin for general observation as well as histochemically for demonstration of complex carbohydrates. Also, stone specimens were embedded in epon and thin sections made by the mineral polishing specimen preparation, and stained along with the kidney tissues. For identifying individual acidic and neutral carbohydrates, the enzyme digestion was performed for some tissue sections prior to histochemical staining. The stone-forming kidney tissues, normal kidney tissues and urinary stones (calcium oxalate, mixed, struvite) contained some glycosaminoglycans and neutral glycoproteins, but uric acid stones and cystine stones did not. The results of digestion with enzymes indicated that calcium oxalate stone-forming kidney tissue contains heparitin (heparan) sulfate; mixed stone-forming tissue contains sialic acid, hyaluronic acid, chondroitin sulfate A, B, C and heparitin (heparan) sulfate; struvite stone-forming tissue contains sialic acid, hyaluronic acid, chondroitin sulfate A, C and heparitin (heparan) sulfate; and cystine stone-forming tissue contains sialic acid, chondroitin sulfate A, C and heparitin (heparan) sulfate. The stone organic matrix is classified into the amorphous and stratiform types. The amorphous type matrix contains chondroitin sulfate A, B, C and heparitin (heparan) sulfate, and the stratiform type matrix also contains sialic acid and hyaluronic acid. The stone-forming kidney tissues, normal kidney tissues and stones (calcium oxalate, mixed, struvite) contain an appreciable amount of alpha-D-glucose, alpha-D-mannose and beta-D-galactose, but the uric acid stones and cystine stones do not contain sugar residues. Since the specific glycosaminoglycan composition differed for kidneys of different mineral content and stones of different morphological type, we believe that some glycosaminoglycans in kidneys and amorphous type matrix might play the role of a nucleating agent, and that a stratiform type matrix encourages stone enlargement.     

Epidemiology and socioeconomic aspects of urolithiasis

Summary This epidemiologic study reveals that the occurrence of urolithiasis in the nineteenth century population in Europe is quite similar to that of the twentieth century in Asia. The analogy is demonstrated for age distribution, stone localization, male/female ratio, and stone composition. The distribution of urolithiasis in a low socioeconomic level population is defined by: highest frequency in childhood, more than 40% bladder stones, less than 20% female patients, less than 40% calcium-oxalate stones, and more than 30% uric acid/urate stones. Typical for a population with a high level these characteristics of urolithiasis are: highest frequency among adults, less than 10% bladder stones, more than 25% female patients, more than 60% calcium oxalate stones, and less than 20% uric acid/urate stones. In partially developed countries those values fall in between.     

Retrograde ureterorenoscopy in the management of ureteral calculi

Endourologic techniques have revolutionized the line of treatment of ureteral stones. The scope of open ureterolithotomy has been narrowed and the contraindications for endoscopic manipulations of ureteric stones became limited. Using the rigid ureterorenoscope (URS) after endoscopic dilatation of the intramural ureter, we have manipulated 45 ureteral stones located at different levels, 33 in the lower ureter (distal ureter), 7 in the middle third and 5 in the upper third (proximal ureter). Successful manipulations occurred in 32 stones (in 21 by retrieval and in 11 by disintegration using ultrasonic lithotripsy). Failures were due to upward dislodgement of the stone in 5 cases to grasp or disintegrate the stone in 2, perforation of the ureter in 2, bleeding from the ureteral wall in 2 cases, to reintroduce guidewire in the ureter and to non-passable stricture below the stone in 1 case each. Delayed complications occurred in 4 patients. Two patients developed ureteral stricture, one suffered vesicoureteral reflux and one ultimately had urethral stricture.     

Assessment of encrustations on polyurethane ureteral stents

PURPOSE: To determine the composition and the extent of crystalline (and other) encrustation on ureteral catheters inserted under sterile conditions in stone formers, in comparison with catheters of the same type inserted in nonstone formers for the same time but for different clinical reasons. MATERIALS AND METHODS: Forty consecutive self-retained polyurethane pigtail ureteral catheters removed by cystoscopy between November 2000 and February 2002 were studied, 30 from stone formers and 10 from patients without stone histories. The mean dwelling time was 55 days for the stone formers and 79 days for the other patients. The encrustations were collected and analyzed with Fourier-transform infrared spectroscopy, powder X-ray diffraction, or both. The stones from nine of the patients were also subjected to the same spectroscopic analysis. Representative sections of the catheters were investigated by scanning electron microscopy and energy-dispersive X-ray analysis. RESULTS: The most common encrustation in stone formers was calcium oxalate monohydrate. In patients without stones, deposits of organic compounds were found consistently. The mean mass of encrustation of stone formers was larger (71.05 mg) than that of patients without stones (1 mg). CONCLUSIONS: Calcium oxalate is the predominant type of encrustation on ureteral catheters in stone formers. Prevention of heavy encrustation should be directed to therapeutic measures concerning calcium oxalate lithiasis and development of new materials by the medical industry that are less prone to encrustation.     

Extracorporeal shock wave lithotripsy of proximal and distal ureteral stones

Extracorporeal shock wave lithotripsy (ESWL) was used for treatment of 105 patients with ureteral stones. There were 77 stones in the upper part of the ureter, i.e. above the pelvic brim, and 28 in the lower part, i.e. below the sacroiliac joint. Successful fragmentation was attained in 101 (96%). In 93% of the patients with stones in the upper ureter and in 100% with stones in the lower ureter the fragments were eliminated completely. In 87% of the patients with stones in the upper ureter, a ureteral catheter was introduced under local anesthesia but without fluoroscopic control. It was thereby possible to remove 30% of the stones from the ureter to the kidney. For the remaining stones, saline was infused through the catheter during ESWL. For patients with stones in the lower part of the ureter, a ureteral catheter was passed in 79% and saline infused during treatment. Whereas some form of anesthesia was used for treatment of all upper ureteral stones, 89% of the treatments for lower ureteral stones were performed without anesthesia. Auxiliary procedures after ESWL were limited to four ureteral catheter manipulations for distal stones. Four proximal stones which remained unaffected by ESWL had to be treated by open surgery (3 stones) or percutaneous surgery (1 stone). Of 82 ureteric stones treated in situ the success fragmentation rate was 95%. The average number of ESWL sessions was 1.04 for both proximal and distal ureteral stones.     

Medical Expulsive Therapy of Ureteral Calculi and Supportive Therapy After Extracorporeal Shock Wave Lithotripsy

ContextMedical expulsive therapy (MET) augments expulsion rates and reduces colic events. Therefore, MET is an appropriate procedure to facilitate stone passage during the observation period in patients who have a newly diagnosed ureteral stone and whose symptoms are controlled. Increasing evidence indicates that supportive therapy following shock wave lithotripsy (SWL) for urolithiasis is also effective.ObjectiveOur aim was to summarize the literature on MET in the treatment of urolithiasis.Evidence acquisitionThis paper is based on a presentation given at the symposium “Terpenes in Urolithiasis” that was held in Düsseldorf, Germany, in 2010.Evidence synthesisMET with α-blockade and calcium channel blockade resulted in accelerated and higher expulsion rates compared with a control group. Higher expulsion rates were demonstrated for the entire ureter, although the vast majority of studies only included distally located stones. MET showed favorable results for renal stones after extracorporeal SWL. The number of necessary analgesic rescue medications, colic episodes, and hospital admissions during treatment periods was reduced.ConclusionsMET facilitates ureteral stone passage during the observation period in patients who have a newly diagnosed ureteral stone <10 mm and whose symptoms are controlled. In patients harboring renal stones undergoing SWL, stone expulsion is augmented as well. Large-scale placebo-controlled randomized trials and the investigation of promising new substances are still needed to better define the future role of MET.     

Pediatric ureteroscopic stone management

PURPOSE: We reviewed our experience of 5 years using ureteroscopy with laser lithotripsy to treat stone disease in prepubertal children. MATERIALS AND METHODS: A retrospective review was performed of all ureteroscopic procedures performed in prepubertal children. RESULTS: A total of 33 ureteroscopic procedures were performed in 29 prepubertal children (15 males and 14 females) 5 to 144 months old (mean age 94 months, including 3 patients 24 months or younger). Stones were located in the renal pelvis in 1 case (3%), proximal ureter in 3 (9%), mid ureter in 5 (15%) and distal ureter in 24 (73%). Stone size ranged from 3 to 14 mm (mean 6). Eight patients required balloon dilation of the ureteral orifice. Followup ranged from 1 to 66 months (mean 11). Stone-free rate after initial ureteroscopy and laser lithotripsy was 88%, with all distal and mid ureteral stones (3 to 9 mm, mean 5) successfully treated. Three patients with proximal ureteral stones 7 to 14 mm in diameter (mean 10.3) required a secondary procedure (repeat ureteroscopy in 2 and shock wave lithotripsy in 1) to become stone-free. One patient with cystinuria and a renal pelvic stone measuring 14 mm required shock wave lithotripsy and percutaneous nephrostolithotomy. There were no major complications of ureteroscopy but there was 1 case of extravasation at the ureterovesical junction after balloon dilation that was managed with stent placement. CONCLUSIONS: Although more patients and longer followup are needed, ureteroscopy with laser lithotripsy is an excellent first line treatment for children with stones in whom conservative therapy fails, especially those with distal and mid ureteral stones. Patients with a stone burden of 10 mm or greater, especially in the proximal ureter, likely will require a secondary procedure to become stone-free.     

广东东莞地区416例泌尿系结石成分分析

目的 应用红外光谱法测定东莞地区泌尿系结石化学成分,探讨本地区泌尿系结石患者的尿路结石成分特点,为本地区泌尿系结石的深化治疗、防止结石复发及预防提供科学依据.方法 收集经自行排出、碎石后排出或手术中取出的泌尿系结石标本416例,应用溴化钾压片技术的红外光谱法对其化学成分进行定性分析.结果 416例泌尿系结石患者中男性居多,占66.8%(278/416),女性占33.2%(138/416);上尿路结石占88.2%,下尿路结石(膀胱结石居多)占11.8%;结石成分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、六水磷酸铵镁和尿酸铵6种化学成分.单一成分结石163例(一水草酸钙/无水尿酸/碳酸磷灰石/六水磷酸铵镁:98/56/6/3),占39.2%;混合成分结石253例,占60.8%,其中以草酸钙和碳酸磷灰石的混合结石为主(188/253).所有结石标本中草酸钙检出率最高,占80.5%(335/416),其次为碳酸磷灰石(49.3%)及无水尿酸(17.3%);膀胱结石成分以一水草酸钙或无水尿酸为主.结论 东莞为全国泌尿系结石最高发地区,其结石成分以草酸钙和碳酸磷灰石为主,单一成分结石亦占相当比例.尿路结石成分分析对了解结石成因可提供重要的线索,对临床制定个性化治疗方案、预防结石形成及复发具有重要意义.