Ho Won Kang1, Sung Pil Seo1, Whi-An Kwon2, Seung Hyo Woo3, Won Tae Kim1, Yong-June Kim1, Seok-Joong Yun1, Sang-Cheol Lee4, Wun-Jae Kim1. 1. Department of Urology, College of Medicine, Chungbuk National University, Cheongju, Republic of Korea. 2. Department of Urology, Wonkwang University Sanbon Hospital, Gunpo, Republic of Korea. 3. Department of Urology, College of Medicine, Eulji University, Daejeon, Republic of Korea. 4. Department of Urology, College of Medicine, Chungbuk National University, Cheongju, Republic of Korea. Electronic address: lscuro@chungbuk.ac.kr.
Abstract
OBJECTIVE: To characterize the clinical and metabolic abnormalities of patients presenting with multiple stones and determine their risk of new stone formation. MATERIALS AND METHODS: This retrospective case-controlled study consisted of 911 patients who had ureter stones for the first time and 107 age- and sex-matched patients without stones. The patients were classified into 2 groups: those with a single ureter stone (n = 690) and those with 1 or more additional stones somewhere in the ureter or kidney (n = 221). All patients underwent 24-hour urinary metabolic evaluation. The 240 patients (26.3%) who were followed for >12 months (median follow-up, 35.0 months) were included in recurrence analyses. Stone recurrence was defined as "new stone formation," namely, the radiographic appearance of stones that had not been present in previous examinations. RESULTS: The multiple-stone group had significantly lower urinary citrate excretion than the single-stone (P = .011) and control (P = .003) groups. Compared with the single-stone group, it also had a higher incidence of hypocitraturia (P = .011) and stone recurrence (27 of 84 [32.1%] vs 29 of 156 [18.6%] patients; P = .025). Multivariate Cox regression analyses revealed that stone multiplicity (hazard ratio, 2.343; 95% confidence interval, 1.302-4.220; P = .005) was an independent predictor of recurrent stone formation. Kaplan-Meier curves showed identical results. CONCLUSION: The patients with multiple stones had distinct metabolic characteristics, particularly hypocitraturia and a significantly higher risk of recurrence than patients with 1 stone. Patients with multiple stones, even if it is their first stone episode, should undergo metabolic evaluation and possibly also potassium citrate therapy to prevent future stones.
OBJECTIVE: To characterize the clinical and metabolic abnormalities of patients presenting with multiple stones and determine their risk of new stone formation. MATERIALS AND METHODS: This retrospective case-controlled study consisted of 911 patients who had ureter stones for the first time and 107 age- and sex-matched patients without stones. The patients were classified into 2 groups: those with a single ureter stone (n = 690) and those with 1 or more additional stones somewhere in the ureter or kidney (n = 221). All patients underwent 24-hour urinary metabolic evaluation. The 240 patients (26.3%) who were followed for >12 months (median follow-up, 35.0 months) were included in recurrence analyses. Stone recurrence was defined as "new stone formation," namely, the radiographic appearance of stones that had not been present in previous examinations. RESULTS: The multiple-stone group had significantly lower urinary citrate excretion than the single-stone (P = .011) and control (P = .003) groups. Compared with the single-stone group, it also had a higher incidence of hypocitraturia (P = .011) and stone recurrence (27 of 84 [32.1%] vs 29 of 156 [18.6%] patients; P = .025). Multivariate Cox regression analyses revealed that stone multiplicity (hazard ratio, 2.343; 95% confidence interval, 1.302-4.220; P = .005) was an independent predictor of recurrent stone formation. Kaplan-Meier curves showed identical results. CONCLUSION: The patients with multiple stones had distinct metabolic characteristics, particularly hypocitraturia and a significantly higher risk of recurrence than patients with 1 stone. Patients with multiple stones, even if it is their first stone episode, should undergo metabolic evaluation and possibly also potassium citrate therapy to prevent future stones.
Authors: Alexandru Cealan; Radu-Tudor Coman; Vasile Simon; Iulia Andras; Teodora Telecan; Ioan Coman; Nicolae Crisan Journal: Med Pharm Rep Date: 2019-04-25
Authors: Joel E Abbott; Daniel L Miller; William Shi; David Wenzler; Fuad F Elkhoury; Nishant D Patel; Roger L Sur Journal: Investig Clin Urol Date: 2017-07-24