Patients treated for uric acid stones reoccur more often and within a shorter interval in comparison to patients treated for calcium stones

Authors

  • Amihay Nevo Rabin medical center
  • Oleg Levi
  • Ami Sidi
  • Alexander Tsivian
  • Jack Baniel
  • David Margel
  • David Lifshitz

DOI:

https://doi.org/10.5489/cuaj.6259

Keywords:

Stone composition, Recurrence

Abstract

Introduction: We aimed to investigate the association between stone composition and recurrence rate in a well-characterized group of patients.

Methods: From our prospectively assembled database of 1328 patients undergoing ureteroscopy and percutaneous nephrolithotomy (PCNL) between 2010 and 2015, we identified 457 patients who met the inclusion criteria: a minimum of two years’ followup, stone-free status following surgery, normal anatomy, and Fourier transform infrared (FT-IR) stone analysis results. Stone recurrence was identified by kidney-ureter-bladder (KUB) or an ultrasound (US). All symptomatic events were recorded. Kaplan-Meier and Cox proportional hazard regression methods were used to assess the differences in recurrence rates and associated risk factors.

Results: Calcium oxalate (CaOx), uric acid (UA), and struvite stones were found in 298 (65.2%), 99 (21.7%), and 28 (6.1%) patients, respectively. During a median followup of 38 months (interquartile range [IQR] 31–48), stone recurred in 111 (24%) patients. One-year stone-free rates (SFRs) stratified by composition were: CaOx 98%, UA 91.9%, calcium phosphate 90%, struvite 88%, and, cystine 83%; the two-year SFRs were 92.6%, 82.7%, 80%, 73%, and 75%, respectively. On multivariate Cox regression analysis, UA composition, the absence of medical preventive therapy, and preoperative stone burden were associated with a shorter time to recurrence. Secondary intervention for recurrent, symptomatic stones was required in 11 (11.1%) and 22 (7.4%) of patients with UA and CaOx stones, respectively (p=0.02).

Conclusions: UA stone-formers are more likely to have a recurrence and to undergo surgical intervention in comparison to CaOx stone-formers, regardless of medical preventive treatment. These differences are more prominent during the first year of followup and should be incorporated into the patient’s followup protocol.

Downloads

Download data is not yet available.

Published

2020-06-05

How to Cite

Nevo, A., Levi , O. ., Sidi, A. ., Tsivian , A. ., Baniel, J. ., Margel, D. ., & Lifshitz, D. . (2020). Patients treated for uric acid stones reoccur more often and within a shorter interval in comparison to patients treated for calcium stones. Canadian Urological Association Journal, 14(11), E555–9. https://doi.org/10.5489/cuaj.6259

Issue

Section

Original Research