Oral chemolysis is an effective, non-invasive therapy for urinary stones suspected of uric acid content.
Nephrolithiasis
Oral chemolysis
Uric acid
Urine alkalization
Urolithiasis
Journal
Urolithiasis
ISSN: 2194-7236
Titre abrégé: Urolithiasis
Pays: Germany
ID NLM: 101602699
Informations de publication
Date de publication:
Dec 2020
Dec 2020
Historique:
received:
05
05
2020
accepted:
27
07
2020
pubmed:
10
8
2020
medline:
4
6
2021
entrez:
10
8
2020
Statut:
ppublish
Résumé
Despite the possible benefit from avoiding stone surgery with all its possible complications, oral chemolysis is rarely performed in patients with urinary stones suspected of uric acid content. Among the reasons for its limited use is the sparse and low-quality data on its efficacy and the lack of reliable factors predicting its outcome. We thus performed a retrospective single-center cohort study of 216 patients (median patient age 63 years) with 272 renal (48%) and/or ureteral (52%) stones treated with oral chemolysis from 01/2010 to 12/2019. Patients with low urine pH (< 6), low stone density upon non-contrast enhanced computed tomography (NCCT), radiolucent urinary stones on plain radiography, and/or a history of uric acid urolithiasis were included. Potassium citrate and/or sodium/magnesium bicarbonate were used for alkalization (target urine pH 6.5-7.2). Median stone size was 9 mm, median stone density 430 Hounsfield Units. Patients with ureteral stones < 6 mm were excluded since stones this small are very likely to pass spontaneously. The stone-free status of each patient was evaluated after 3 months using NCCT. Oral chemolysis was effective with a complete and partial response rate of stones at 3 months of 61% and 14%, respectively; 25% of stones could not be dissolved. Lower stone density (OR = 0.997 [CI 0.994-0.999]; p = 0.008) and smaller stone size (OR = 0.959 [CI 0.924-0.995]; p = 0.025) significantly increased the success rate of oral chemolysis in multivariate logistic regression analysis. More precise stone diagnostics to exclude non-uric-acid stones could further improve outcome.
Identifiants
pubmed: 32770255
doi: 10.1007/s00240-020-01204-8
pii: 10.1007/s00240-020-01204-8
pmc: PMC7666279
doi:
Substances chimiques
Bicarbonates
0
Uric Acid
268B43MJ25
Potassium Citrate
EE90ONI6FF
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
501-507Références
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