Abstract
Introduction
To describe the outcomes and quantify the rate of uric acid stone medical dissolution therapy using automated, software-generated stone volume measurements.
Methods
A sample of patients treated with oral dissolution therapy was reviewed from a single institution between 2008 and 2019. Baseline patient demographics, metabolic urine testing and stone characteristics were collected. Computed tomography (CT) scan images were evaluated using the quantitative Stone Analysis Software (qSAS) to obtain total stone volume (TSV), maximum diameter (MD) and stone number. Rate of dissolution using total stone volume was calculated over the treatment period.
Results
Twenty-seven patients were started on oral dissolution therapy, corrected for renal function. After mean duration of 180 days (range 41–531), 16 patients failed treatment resulting in surgical therapy. Twenty stones in 11 patients showed complete or partial dissolution. Compared to those who failed treatment, patients with complete or partial dissolution had lower 24 h urinary uric acid and higher treatment urine pH. Thirteen (65%) stones showed complete dissolution after a mean 167.6 days. Rate of change for responders was 4.73 mm3 or 0.6% of total stone volume per day. Time to dissolution of one half of stone volume based on total stone volume was 86 days (12.30 weeks).
Discussion/conclusions
Software-calculated total stone volume may be an effective method of measuring uric acid stone response to oral alkalization therapy. Stone volume decreased by 50% after 12.3 weeks of treatment and could be an important benchmark for oral dissolution therapyoral dissolution therapy. Further studies with a larger sample and validation of the software are needed to confirm if this can be used to guide surveillance schedules for dissolution therapy.
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Availability of data and material
Raw data are available upon request.
Code availability
qSAS software is available for investigational use at https://ctcicblog.mayo.edu/hubcap/qsas-stone-toolkit/.
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Acknowledgements
O’Brien Urology Research Center, funded by the National Institutes of Health (DK100277), and the CT Clinical Innovation Center at the Mayo Clinic.
Funding
No funding sources were used for the conduct of the study.
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JM: study design, data collection, data analysis, manuscript preparation and review; AN study design, data collection, data analysis; SS data collection; MK manuscript preparation and review; KS manuscript preparation and review; MH study design, manuscript preparation and review.
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Mitchell Humphreys disclosures unrelated to current research study with Boston Scientific (research support), Adva-Tech (research support), and J&J (consultant).
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Institutional Review Board approval was obtained for the conduct of this study.
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Individual consent from patients was not required due to the retrospective nature of study, as determined by the Institutional Review Board.
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Moore, J., Nevo, A., Salih, S. et al. Outcomes and rates of dissolution therapy for uric acid stones. J Nephrol 35, 665–669 (2022). https://doi.org/10.1007/s40620-021-01094-y
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DOI: https://doi.org/10.1007/s40620-021-01094-y