Results of urinary dissolution therapy for radiolucent calculi

Abstract

Purpose: In this paper we present our experience with dissolution therapy of radiolucent calculi. Materials and Methods:This was a retrospective analysis of patients who were offered urinary dissolution therapy between January 2010 and June 2011. Patients were treated with tablets containing potassium citrate and magnesium oxide. Partial dissolution was defined as at least a 50% reduction in stone size. Patients with complete or partial dissolution were classified in the successful dissolution group. Patients with no change, inadequate reduction, increase in stone size and those unable to tolerate alkali therapy were classified as failures. Patient sex, stenting before alkalinization, stone size, urine pH at presentation and serum uric acid levels were analyzed using Fisher t-test for an association with successful dissolution. Results: Out of 67, 48 patients reported for follow up. 10 (15%) had complete dissolution and 13 (19%) had partial dissolution. Alkalinization was unsuccessful in achieving dissolution in 25 (37%). Stenting before alkalinization, patient weight (< 60 vs. > 75kg) and serum uric acid levels (≤ 6 vs. > 6) were the only factors to significantly affected dissolution rates (p = 0.039, p 0.035, p 0.01 respectively). Conclusions: A policy of offering dissolution therapy to patients with radiolucent calculi had a successful outcome in 34% of patients.

Flexible Ureteroscopic Management of Horseshoe Kidney Renal Calculi

“…We suggest that once acute symptoms resolved, patients with small lower calyceal residual stones go on regular monitoring, and wait to receive other treatment modality such as PNL if inevitably required in the future. Patients with stone disease should also undergo metabolic evaluation and adjust their diet accordingly to minimize the risk of stone recurrence since metabolic abnormalities contribute to stone formation greatly, and proper medical therapy might aid in the future ( 31 ).…”

Medical therapy for nephrolithiasis: State of the art

“…Combining these demographics with stone size and Hounsfield units on CT scan may contribute to better diagnostic accuracy in identifying patients with pure uric acid stones who may be successfully treated with dissolution therapy. Complete dissolution may occur in as little as 6 weeks to 6 months or more [124] , [125] , likely due to the varying percentages of uric acid stone composition [123] .…”

Medical treatment of uric acid kidney stones

“…All the staghorn calculi were dissolved. The reported success rates of oral dissolution therapy in the literature range from 15 to 87% of stones [10,11,[24][25][26][27][28][29][30]. In the recent review by Ong et al including 1075 patients, a complete or partial dissolution rate was respectively 61.7% and 19.8%, while 15.7% of patients required surgical intervention [30].…”