Stone composition independently predicts stone size in 18,029 spontaneously passed stones

Abstract

Purpose

To evaluate whether the size of spontaneously passed stones (SPS) may be associated with clinical parameters.

Methods

A search for SPS was conducted in our electronic stone database, comprising data on stones analyzed over the last 33 years at our institution. Adults with upper urinary tract stones were included. Cases with stenotic urinary tract disease or past history of anastomotic urinary tract surgery were excluded. Stone size expressed as maximal stone diameter (MSD) and stone volume (SV) was compared between groups by one-way ANOVA. Logistic regression analyses were performed to identify predictors of MSD ≥ 6 mm.

Results

Overall mean MSD and SV for 18,029 SPS was 4.1 mm and 11.5 mm3, respectively, and significantly differed between stone composition groups (p < 0.001). The lowest mean MSD and SV were found for calcium oxalate monohydrate (3.6 mm and 9.0 mm3, respectively) and the highest mean MSD and SV were found for struvite (7.9 mm and 61.0 mm3, respectively). Stone composition and increasing age were found to be independent predictors of MSD ≥ 6 mm (both p < 0.001). Sex differentiation did not contribute as a predictor of MSD ≥ 6 mm.

Conclusions

Stone composition and—to a lesser extent—age serve as independent predictors of size of spontaneously passed stones. Of particular importance, large spontaneously passed stones of ≥ 6 mm may be frequently found in cystine, brushite or struvite stone formers, whereas a minority of all calcium oxalate stones exceed that cutoff. Future studies shall evaluate these parameters as possible predictors of spontaneous stone passage.

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Acknowledgements

We wish to thank Philippe Autier, MD, MPH, PhD, Senior Faculty of the International Prevention Research Institute in Lyon for statistical assistance and review.

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Authors

Contributions

EXK: protocol/project development, data analysis and manuscript writing/editing; VDC: protocol/project development, data analysis and manuscript writing/editing; MA: manuscript writing/editing; SD: data analysis and manuscript writing/editing; MD: protocol/project development, data collection or management, data analysis and manuscript writing/editing; OT: protocol/project development, data analysis and manuscript writing/editing.

Corresponding author

Correspondence to Olivier Traxer.

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Conflict of interest

Olivier Traxer is a consultant for Coloplast, Rocamed, Olympus, EMS and Boston Scientific. Steeve Doizi is a consultant for Coloplast. Etienne Xavier Keller is supported by a Travel Grant from the University Hospital Zurich and from the Kurt and Senta Herrmann Foundation. Vincent De Coninck is supported by the EUSP scholarship from the European Association of Urology and by a grant from the Belgische Vereniging voor Urologie (BVU).

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Supplementary Figure 1 Flow diagram of stones listed in our stone database and cases available for analysis in this study. *Whenever more than two SPS were available per case, characteristics of the SPS with the largest MSD were considered (png 155 kb)

Supplementary Figure 2 Proportion of stones with a maximal diameter of ≥6 mm per stone composition category. COM = calcium oxalate monohydrate; COD = calcium oxalate dihydrate; UA0 = anhydrous uric acid; UA2 = uric acid dihydrate; CA = carbapatite; STR = struvite; BR = brushite; CYS = cystine (png 94 kb)

Supplementary Figure 3 Distribution of stones with a MSD ≥6 mm over age groups, separately for each stone composition category. COM = calcium oxalate monohydrate; COD = calcium oxalate dihydrate; UA0 = anhydrous uric acid; UA2 = uric acid dihydrate; CA = carbapatite; STR = struvite; BR = brushite; CYS = cystine (png 831 kb)

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Keller, E.X., De Coninck, V., Audouin, M. et al. Stone composition independently predicts stone size in 18,029 spontaneously passed stones. World J Urol 37, 2493–2499 (2019). https://doi.org/10.1007/s00345-018-02627-0

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Keywords

  • Urinary stone
  • Stone size
  • Stone composition
  • Spontaneous passage
  • Age
  • Recommendations
  • Adults