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] .…”

Is medical dissolution treatment for uric acid stones more cost-effective than surgical treatment? A novel, solo practice retrospective cost-analysis of medical vs. surgical therapy

“…Patients who subsequently underwent surgical intervention were found to have a small component of calcium oxalate withint heir final stone composition. 18 CT scanners are available worldwide and have a better ability to differentiate uric acid from calcium-based stones, but overlap still exists between calcium and uric acid stones. 19 Even dual-energy CT, which has been shown to be extremely accurate in identifying various stone compositions, is limited in the evaluation of small stones, with sensitivity to detect uric acid stones at only 88% currently.…”