Cancer as a risk factor for urinary tract calculi: a retrospective cohort study using ‘The Health Improvement Network’

Cancer and urinary tract calculi
  • Ankush Mittal
  • Motaz Elmahdy Hassan
  • Joht Singh Chandan
  • Brian H. Willis
  • Krishnarajah NirantharakumarEmail author
  • Kesvapilla Subramonian
Original Paper



Urolithiasis is a common condition that poses significant morbidity to patients. There are similarities in the development of certain cancers and urinary tract calculi (UTC), however, little is known about their temporal relationship. This study aims to identify if cancer is a risk factor for the development of UTC.


A population-based retrospective cohort study was conducted for the period 1st January 1990 to 1st May 2016. 124,901 exposed patients identified using clinical codes with newly diagnosed cancer were matched to 476,203 unexposed controls by age, gender, BMI, and general practice. The main outcome measure was the risk of developing UTC described by hazard ratios.


There were 512 incident UTC events in the cancer group compared to 1787 in the unexposed controls. This translated to an adjusted hazard ratio of 1.26 (95% CI 1.14–1.39; p < 0.001). A sub-analysis assessing cancer-specific effects demonstrated increased risks for 10 out of 12 common cancers, most significantly in bladder, colorectal and prostate cancer.


This study demonstrated a 26% increased risk of UTC in cancer patients suggesting wider recognition of this risk amongst clinicians could improve diagnosis and prevention of UTC, as well as encourage further research exploring this association.


Urinary Calculus Stone Urolithiasis Cancer Cohort Risk 


Author contributions

KS and MH conceptualised the study question based on their clinical experience and specialism in the management of urinary tract calculi. KN was primarily involved in developing the study methodology and providing academic supervision for the study. AM completed the literature review and statistical analysis, with support from JSC and BW. AM and JSC revised the manuscript for submission, with support from ME, KS and KN.



Compliance with ethical standards

Conflict of interest

The authors have no conflicts of interest to declare.

Ethical approval

There was no legal requirement to obtain patient consent for this study. Although consent was not obtained from patients for data extraction, all data extracted was anonymised and modelled with low risk of identification. Studies analysing data using The Health Improvement Network (THIN) database have ethical approval from the NHS South-East Multicentre Research Ethics Committee, subject to prior independent scientific review. The Scientific Review Committee (IMS Health) approved the study protocol before we performed our analysis (SRC Reference Number: 17THIN007).

Data sharing and accessibility

Full dataset available from the corresponding author at

Supplementary material

240_2019_1127_MOESM1_ESM.pdf (483 kb)
Supplementary material 1 (PDF 482 KB)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Institute of Applied Health ResearchUniversity of BirminghamBirminghamUK
  2. 2.Department of UrologyUniversity Hospitals Birmingham NHS Foundation TrustBirminghamUK

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