Struvite Stones

Rodman, JohnS.

doi:10.1159/000046299

Cited by 64 publications

(34 citation statements)

References 25 publications

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“…If clinical and laboratory findings are evaluated more accurately (history of urinary tract infections, alkaline urine, and radiographic appearance) and more experience is gained, the detection rate of struvite stones can be increased [45].…”

Section: Discussionmentioning

confidence: 99%

Determination of urinary calculi by binocular stereoscopic microscopy

Nayır

2002

Pediatr Nephrol

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Because of the inadequacies of chemical methods for identifying urinary calculi, mineralogical methods have been developed, but these methods are sometimes time consuming and expensive. The aim of the study was to evaluate urinary calculi with binocular stereoscopic microscopy (BSM), X-ray diffraction (XRD), scanning electron microscopy (SEM), and biochemical methods and to determine the specificity of BSM. A total of 30 pediatric patients with urinary calculi (17 girls and 13 boys), from 6 months to 19 years of age, were included in the study. The calculi obtained were evaluated with a Novex-AP 8 BSM, a Shimadzu 6000 XRD device, a Jeol JXA 733 SEM, and a biochemical kit from Merck. In 2 cases BSM rapidly determined that the material was not from the urinary system. Except for 2 cases, BSM results were identical to the results obtained by XRD. In 2 non-identifiable cases, the samples were struvite with an amorphous structure. The sensitivity of BSM was 93%. The small size of calculi did not permit biochemical analysis in 4 cases. In another group of 4 cases, the results of biochemical analysis did not agree with the XRD. In 7 cases, calcium phosphate was found by biochemical assay, although it was not confirmed by XRD. The sensitivity of biochemical analysis was 58%. BSM is more reliable than biochemical methods. BSM can be used for a rapid, reliable evaluation of the urinary calculi. It gives additional information about the nidus, the crystalline structure, and the order of deposition of components. The clinician can perform this investigation himself, obtaining very useful information about stone formation that allows an immediate start of medical treatment, decreasing recurrences.

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Section: Discussionmentioning

confidence: 99%

Determination of urinary calculi by binocular stereoscopic microscopy

Nayır

2002

Pediatr Nephrol

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“…Common anatomic abnormalities that can contribute to infection stone formation are infundibular stenosis, ureteropelvic junction obstruction, vesicoureteral reflux, urinary diversion, and urinary augmentation with bowel [15]. Up to 20% of urinary diversion patients will develop renal calculi as a result of chronic colonization of the intestinal diversion with bacteria [16].…”

Section: Clinical Features Of Infection Stonesmentioning

confidence: 99%

Infection-Related Kidney Stones

Krambeck

Lieske

2011

Clinic Rev Bone Miner Metab

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Infection and stones can be associated in two ways. Stone disease can occur due to infection by an organism that expresses the urea-splitting enzyme urease (infection stones). Nephrolithiasis can also be complicated by urinary tract infection that in turn was caused by obstruction of the urinary tract by a stone and/or colonization of a pre-existing stone, in both cases by non-urease producing organisms. Although the incidence of infection stones appears to have declined over recent years in the United States, they remain a cause of significant morbidity and mortality. A strong index of suspicion is necessary to identify infection stones before they become large, damage kidneys, or lead to acute morbidity such as urosepsis. Surgery remains the mainstay of therapy for infection stones, combined with careful attention to antibiotic choice based upon appropriate culture results. Use of medical therapy alone is reserved for those relatively unusual cases in which there is a strong contraindication to surgery. Infection-related stones also require prompt recognition, often via use of non-contrast CT. Any obstruction that is present needs to be promptly relieved in order to decompress the kidney and allow the infection to be cleared by antibiotics chosen based upon culture results.

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“…They are formed in alkaline urine through the action of urea-splitting organisms such as Proteus, Klebsiella and Pseudomonas. [1,2] This process is facilitated by the action of urease enzyme that breaks down urea into ammonia and carbon dioxide, which both respectively hydrolyze into ammonia and bicarbonate, thus alkalinizing the urine. This milieu favours formation of struvite and carbonate apatite stones.…”

Section: Introductionmentioning

confidence: 99%

“…This milieu favours formation of struvite and carbonate apatite stones. [1,2] As a potent irreversible inhibitor of bacterial urease, acetohydroxamic acid (Lithostat, Mission Pharmacal, San Antonio, USA), was described in 1965. [3] In a randomized clinical trial, Williams et al [4] found that 7 patients (36.8%) who received placebo developed de novo urolithiasis when compared with none of the 18 patients who received acetohydroxamic acid (p<0.01).…”

Section: Introductionmentioning

confidence: 99%

Is it safe to prescribe ascorbic acid for urinary acidification in stone-forming patients with alkaline urine?

Noureldin

Silva

Fahmy

et al. 2017

Turkish Journal of Urology

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Objective: To study the effect of ascorbic acid (AA) supplementation on urinary pH, metabolic stone workup parameters, and development of de novo urolithiasis in stone-forming patients. Material and methods:A retrospective review of the patients followed-up at a tertiary stone centre between September 2009 and October 2015 was performed. Patients with recurrent urolithiasis who received AA supplementation as a urinary acidifying agent were included in the study. Detailed metabolic stone work-up, including two 24-hour urine collections obtained pre-and post-AA supplementation were compared. In addition, imaging studies were reviewed to assess the development of de novo urolithiasis.Results: Twenty-four patients were included in the study with a mean age of 60.6 years and a median daily AA dose of 1000 mg (range: 500-2000 mg). Median follow-up period was 22.6 months (range: 19.7-32.1). After AA supplementation, there was a significant decrease in urinary pH (7.6 vs. 6.9, p= 0.02). Although there was no significant increase in the daily oxalate excretion, two patients (8.3%) had their AA dose reduced or discontinued due to de novo hyperoxaluria (342.9 vs 510.2 umol/day; p= 0.75). Other serum and urinary parameters did not show any significant changes. Eight (33.3%) patients developed de novo urolithiasis with struvite and carbonate apatite being the major components. Conclusion:AA supplementation resulted in significantly lower urinary pH in patients with recurrent urolithiasis and alkaline urine pH. Prospective studies are needed to assess whether this reduction in urinary pH is associated with lower stone recurrence rates.

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Struvite Stones

Cited by 64 publications

References 25 publications

Determination of urinary calculi by binocular stereoscopic microscopy

Determination of urinary calculi by binocular stereoscopic microscopy

Infection-Related Kidney Stones

Is it safe to prescribe ascorbic acid for urinary acidification in stone-forming patients with alkaline urine?

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