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Advancements in stone classification: unveiling the beauty of urolithiasis

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Abstract

Purpose

Urolithiasis has become increasingly prevalent, leading to higher disability-adjusted life years and deaths. Various stone classification systems have been developed to enhance the understanding of lithogenesis, aid urologists in treatment decisions, and predict recurrence risk. The aim of this manuscript is to provide an overview of different stone classification criteria.

Methods

Two authors conducted a review of literature on studies relating to the classification of urolithiasis. A narrative synthesis for analysis of the studies was used.

Results

Stones can be categorized based on anatomical position, size, medical imaging features, risk of recurrence, etiology, composition, and morphoconstitutional analysis. The first three mentioned offer a straightforward approach to stone classification, directly influencing treatment recommendations. With the routine use of CT imaging before treatment, precise details like anatomical location, stone dimensions, and Hounsfield Units can be easily determined, aiding treatment planning. In contrast, classifying stones based on risk of recurrence and etiology is more complex due to dependencies on multiple variables, including stone composition and morphology. A classification system based on morphoconstitutional analysis, which combines morphological stone appearance and chemical composition, has demonstrated its value. It allows for the rapid identification of crystalline phase principles, the detection of crystalline conversion processes, the determination of etiopathogenesis, the recognition of lithogenic processes, the assessment of crystal formation speed, related recurrence rates, and guidance for selecting appropriate treatment modalities.

Conclusions

Recognizing that no single classification system can comprehensively cover all aspects, the integration of all classification approaches is essential for tailoring urolithiasis patient-specific management.

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Acknowledgements

Our special thanks go to Michel Daudon (Laboratoire des Lithiases, Service des Explorations Fonctionnelles Multidisciplinaires, AP-HP, Hôpital Tenon, Paris, France) for proofreading this article.

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Authors and Affiliations

  1. Department of Urology, Augustijnslei 100, Klina, 2930, Brasschaat, AZ, Belgium

    Vincent De Coninck

  2. Young Academic Urologists (YAU), Urolithiasis and Endourology Working Party, Arnhem, The Netherlands

    Vincent De Coninck & Etienne Xavier Keller

  3. Department of Urology, National and Kapodistrian University of Athens, Athens, Greece

    Andreas Skolarikos

  4. Department of Urology, Haukeland University Hospital, Bergen, Norway

    Patrick Juliebø-Jones

  5. Faculty of Medicine, University Hospitals Leuven, Louvain, Belgium

    Manu Joris

  6. GRC N°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, Arnhem, The Netherlands

    Olivier Traxer

  7. Service d’Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, Arnhem, The Netherlands

    Olivier Traxer

  8. Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland

    Etienne Xavier Keller

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VDC: protocol/project development, data collection or management, data analysis, manuscript writing/editing. AS: protocol/project development, manuscript writing/editing. PJ-J: manuscript writing/editing. MJ: manuscript writing/editing. OT: research concept, protocol/project development. EXK: research concept, protocol/project development, data collection or management, data analysis, manuscript writing/editing.

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Vincent De Coninck is a speaker and/or consultant for BD, Coloplast, and Karl Storz, and has no specific conflicts relevant to this study. Andreas Skolarikos is a consultant for Boston Scientific, and has no specific conflicts relevant to this study. Olivier Traxer is a consultant for Coloplast, Karl Storz, Rocamed, Quanta Systems, Ambu, Boston Scientific, and IPG Medical, and has no specific conflicts relevant to this study. Etienne Xavier Keller is a speaker and/or consultant for Coloplast, Olympus, Boston Scientific, Recordati, Debiopharm and Alnylam, and has no specific conflicts of interest relevant to this work. All other authors have no conflicts of interest.

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De Coninck, V., Skolarikos, A., Juliebø-Jones, P. et al. Advancements in stone classification: unveiling the beauty of urolithiasis. World J Urol 42, 46 (2024). https://doi.org/10.1007/s00345-023-04746-9

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