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Should metabolic evaluation be performed in patients with struvite stones?

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Abstract

Previous studies suggested that patients with pure struvite calculi rarely have underlying metabolic abnormalities. Therefore, most of these patients do not undergo metabolic studies. We report our experience with these patients and their response to directed medical therapy. Between 1/2005 and 9/2012, 75 patients treated with percutaneous nephrolithotomy for struvite stones were identified. Of these, 7 had pure struvite stones (Group 1), 32 had mixed struvite stones (Group 2), both with metabolic evaluation, and 17 had pure struvite stones without metabolic evaluation (Group 3). The frequency of metabolic abnormalities and stone activity (defined as stone growth or stone-related events) was compared between groups. The median age was 55 years and 64 % were female. No significant difference in race, infection history, family history, stone location or volume existed between groups. Metabolic abnormalities were found in 57 % of Group 1 and 81 % of Group 2 patients. A similar proportion of Group 1 and 2 patients received modification to or continuation of metabolic therapy, whereas no Group 3 patients received any directed therapy. In patients with >6 months follow-up, the stone activity rate between Groups 1 and 2 appeared similar whereas Group 3 trended towards higher stone activity rate. Metabolic abnormalities in pure struvite stone formers appear to be more common than previously reported. Directed medical therapy in these patients may reduce stone activity. The role of metabolic evaluation and directed medical therapy needs reconsideration in patients with pure struvite stones.

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Abbreviations

UTI:

Urinary tract infection

AHA:

Acetohydroxamic acid

PNL:

Percutaneous nephrolithotomy

IVP:

Intravenous pyelogram

NCCT:

Non-contrast computed tomography

KUB/TOMO:

Plain radiograph of the abdomen with tomogram

BMI:

Body mass index

SD:

Standard deviation

IQR:

Interquartile range

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Authors and Affiliations

  1. Division of Urologic Surgery, Duke University Medical Center, Room 1573 White Zone, Box 3167, Durham, NC, 27710, USA

    Muhammad Waqas Iqbal, Richard H. Shin, Adam G. Kaplan, Fernando J. Cabrera, Jonathan Hanna, Charles D. Scales Jr., Michael N. Ferrandino, Glenn M. Preminger & Michael E. Lipkin

  2. Department of Urology, Shifa International Hospital and College of Medicine, H-8/4, Islamabad, 44000, Pakistan

    Muhammad Waqas Iqbal

  3. Urology Department, University of California Irvine, Orange, CA, 92868, USA

    Ramy F. Youssef

  4. Duke Clinical Research Institute, Duke University, DUMC 3707, Durham, NC, 27710, USA

    Charles D. Scales Jr.

Authors
  1. Muhammad Waqas Iqbal
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  2. Richard H. Shin
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  3. Ramy F. Youssef
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  4. Adam G. Kaplan
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  5. Fernando J. Cabrera
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  6. Jonathan Hanna
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  7. Charles D. Scales Jr.
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  8. Michael N. Ferrandino
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  9. Glenn M. Preminger
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  10. Michael E. Lipkin
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Corresponding author

Correspondence to Michael E. Lipkin.

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Conflict of interest

Muhammad Waqas Iqbal, Richard H. Shin, Ramy F. Youssef, Adam G. Kaplan, Fernando J. Cabrera, Jonathan Hanna, and Charles D. Scales declare that they have no conflict of interest. Michael N. Ferrandino is a Proctor for Intuitive Surgical. Glenn M. Preminger is a consultant for Boston Scientific, Mission Pharmacal and has received a speaker honorarium from Olympus. Michael E. Lipkin is a consultant for Boston Scientific and has received a speaker honorarium from Lumenis.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

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For this type of study formal consent is not required.

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This study was investigator initiated; there was no source of funding.

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Iqbal, M.W., Shin, R.H., Youssef, R.F. et al. Should metabolic evaluation be performed in patients with struvite stones?. Urolithiasis 45, 185–192 (2017). https://doi.org/10.1007/s00240-016-0893-6

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  • DOI: https://doi.org/10.1007/s00240-016-0893-6

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