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Selection and Outcomes for Dissolution Therapy in Uric Acid Stones: A Systematic Review of Literature

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Abstract

Purpose of Review

The prevalence of uric acid (UA) urolithiasis contributes significantly to global disease burden, due to high rates of recurrence and diagnostic challenges. Dissolution therapy plays a valuable role in the conservative management of UA calculi, reducing the requirement for surgical intervention. This review summarises the existing evidence for the efficacy of medical dissolution of uric acid urolithiasis.

Recent Findings

A systematic search was conducted of worldwide literature according to PRISMA methodology and Cochrane standards for systematic review. Studies were included if they reported outcome data for the administration of medical therapy for the dissolution of UA calculi. A total of 1075 patients were included in the systematic review. Complete or partial dissolution of UA calculi was observed in 80.5% of patients (865/1075 patients), with 61.7% (647/1048 patients) achieving complete dissolution and 19.8% (207/1048 patients) achieving partial dissolution. A discontinuation rate of 10.2% (110/1075 patients) was noted, and 15.7% (169/1075 patients) required surgical intervention.

Summary

Dissolution therapy is a safe and effective method of conservatively managing uric acid stones in the short term. Despite the significant disease burden of UA calculi, current guidelines are limited by deficiencies in the existing body of research. Further research should be undertaken to develop evidence-based clinical guidelines for diagnosis, treatment, and prevention of UA urolithiasis.

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Authors and Affiliations

  1. Department of Urology, University Hospital Southampton, Southampton, SO16 6YD, UK

    Andrea Ong, George Brown & Bhaskar K. Somani

  2. Department of Urology and Andrology, General Hospital Hall I.T., Milser Str. 10, Hall in Tirol, 6060, Austria

    Theodoros Tokas

  3. Father Muller Medical College Hospital, Mangalore, India

    B. M. Zeeshan Hameed

  4. Bristol Urological Institute, Southmead Hospital, Westbury-on-Trym, Bristol, BS10 5NB, UK

    Joe Philip

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  1. Andrea Ong
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  2. George Brown
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  3. Theodoros Tokas
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  4. B. M. Zeeshan Hameed
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Contributions

AO and GB: data collection and writing. TT, ZH, and JP: editing. BKS: conceptualisation and editing.

Corresponding author

Correspondence to Bhaskar K. Somani.

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Conflict of Interest

The authors wish to highlight that Professor Bhaskar Somani is an endourology section editor for Current Urology Reports. All other authors declare no competing interests. All authors have reviewed and approved the submitted manuscript. We confirm that this work has not been published or submitted for publication elsewhere. All reported studies/experiments with human or animal subjects performed by the authors have been previously published and complied with all applicable ethical standards (including the Helsinki declaration and its amendments, institutional/national research committee standards, and international/national/institutional guidelines). All tables and figures are original.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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Ong, A., Brown, G., Tokas, T. et al. Selection and Outcomes for Dissolution Therapy in Uric Acid Stones: A Systematic Review of Literature. Curr Urol Rep 24, 355–363 (2023). https://doi.org/10.1007/s11934-023-01164-7

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  • DOI: https://doi.org/10.1007/s11934-023-01164-7

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