Urine and stone analysis for the investigation of the renal stone former: a consensus conference

Abstract The Consensus Group deliberated on a number of questions concerning urine and stone analysis over a period of months, and then met to develop consensus. The Group concluded that analyses of urine and stones should be routine in the diagnosis and treatment of urinary stone diseases. At present, the 24-h urine is the most useful type of urine collection, and accepted methods for analysis are described. Patient education is also important for obtaining a proper urine sample. Graphical methods for reporting urine analysis results can be helpful both for the physician and for educating the patient as to proper dietary changes that could be beneficial. Proper analysis of stones is also essential for diagnosis and management of patients. The Consensus Group also agreed that research has shown that evaluation of urinary crystals could be very valuable, but the Group also recognizes that existing methods for assessment of crystalluria do not allow this to be part of stone treatment in many places.

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Infection-related hospitalization following ureteroscopic stone treatment: results from a surgical collaborative

BMC Urology ◽

10.1186/s12894-020-00720-4 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Adam Cole ◽

◽

Jaya Telang ◽

Tae-Kyung Kim ◽

Kavya Swarna ◽

...

Keyword(s):

Risk Factors ◽

Urine Analysis ◽

Patient Characteristics ◽

Urinary Stone ◽

Stone Disease ◽

Urinary Stones ◽

Multivariable Logistic Regression Analysis ◽

Related Complication ◽

Stone Treatment ◽

Urine Testing

Abstract Background Unplanned hospitalization following ureteroscopy (URS) for urinary stone disease is associated with patient morbidity and increased healthcare costs. To this effect, AUA guidelines recommend at least a urinalysis in patients prior to URS. We examined risk factors for infection-related hospitalization following URS for urinary stones in a surgical collaborative. Methods Reducing Operative Complications from Kidney Stones (ROCKS) is a quality improvement (QI) initiative from the Michigan Urological Surgery Improvement Collaborative (MUSIC) consisting of academic and community practices in the State of Michigan. Trained abstractors prospectively record standardized data elements from the health record in a web-based registry including patient characteristics, surgical details and complications. Using the ROCKS registry, we identified all patients undergoing primary URS for urinary stones between June 2016 and October 2017, and determined the proportion hospitalized within 30 days with an infection-related complication. These patients underwent chart review to obtain clinical data related to the hospitalization. Multivariable logistic regression analysis was performed to determine risk factors for hospitalization. Results 1817 URS procedures from 11 practices were analyzed. 43 (2.4%) patients were hospitalized with an infection-related complication, and the mortality rate was 0.2%. Median time to admission and length of stay was 4 and 3 days, respectively. Nine (20.9%) patients did not have a pre-procedure urinalysis or urine culture, which was not different in the non-hospitalized cohort (20.5%). In hospitalized patients, pathogens included gram-negative (61.5%), gram-positive (19.2%), yeast (15.4%), and mixed (3.8%) organisms. Significant factors associated with infection-related hospitalization included higher Charlson comorbidity index, history of recurrent UTI, stone size, intra-operative complication, and procedures where fragments were left in-situ. Conclusions One in 40 patients are hospitalized with an infection-related complication following URS. Awareness of risk factors may allow for individualized counselling and management to reduce these events. Approximately 20% of patients did not have a pre-operative urine analysis or culture, and these findings demonstrate the need for further study to improve urine testing and compliance

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Use of non-contrast computed tomography determined urinary stone fragility in predicting the outcome of extracorporeal shockwave lithotripsy treatment: a single-center study

Journal of Fatima Jinnah Medical University ◽

10.37018/xivf1000 ◽

2020 ◽

Vol 14 (2) ◽

pp. 59-63

Author(s):

Athar Hameed ◽

Khazir Hayyat Gondal

Keyword(s):

Shock Waves ◽

Renal Stone ◽

Plain Film ◽

Renal Stones ◽

Renal Calculus ◽

Urinary Stone ◽

Stone Disease ◽

Urinary Stones ◽

Fisher Exact Test

Background: Renal stones represent a common urological pathology where standard treatment advised is ESWL in current practice. However, NCCT based determination of stone fragility may help to predict the outcome of ESWL treatment, hence optimizing its clinical use. Therefore, this study evaluated the role of NCCT determined urinary stone fragility in predicting the outcome of ESWL treatment in local clinical settings. Patients and methods: One hundred patients with single renal calculus of 0.6-2 cm in size were included. NCCT based determination of stone fragility in HU units was done for all patients. Patients were then subjected to ESWL, with a maximum of 3000 shock waves given per ESWL session. Plain film and/or ultrasonography was used to monitor ESWL treatment progress with a final NCCT evaluation at 12 weeks to determine the clearance of the calculi for each patient. Association of NCCT based stone fragility and outcome of ESWL was statistically analyzed using Fisher exact test. Results: The mean age of the patients was 37.7 ± 10.9 years with 54% being male. Decreasing stone fragility on NCCT (high = <500HU, moderate = 500-1000HU, and high = 1000HU) required more number and intensity of ESWL sessions (1-2 visits and 3000-6000 shock waves for high stone fragility group, 3-5 visits and 7000-18000 shock waves for the moderate group, and 6 visits and >18000 shock waves for low fragility group, respectively) necessary for clearance of urinary stones (p<0.001). In 98% of patients, the clearance of urinary stones was excellent. Conclusion: Renal stone patients with NCCT determined high and moderate stone fragility show an optimal response after ESWL treatment, whereas, for low fragility renal stones attenuative treatment like percutaneous nephrolithotomy and/or ureteroscopy should be considered instead of ESWL. This approach can enable patient stratification before ESWL therapy ensuring better clinical management of the renal stone disease.

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Bone Mineral Content in Renal Stone Former (RSF) Patients With Idiopathic Hypercalciuria

Urolithiasis 2 ◽

10.1007/978-1-4615-2556-1_23 ◽

1994 ◽

pp. 86-86

Author(s):

I. P. Heilberg ◽

L. A. Martini ◽

V. L. Szejnfeld ◽

A. B. Carvalho ◽

S. A. Draibe ◽

...

Keyword(s):

Bone Mineral Content ◽

Bone Mineral ◽

Mineral Content ◽

Renal Stone ◽

Idiopathic Hypercalciuria ◽

Stone Former

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Consensus Statement on Urinary Stone Treatment During A Pandemic: A Delphi Process from the Endourological Society TOWER Research Initiative

Journal of Endourology ◽

10.1089/end.2021.0477 ◽

2022 ◽

Author(s):

Kymora Scotland ◽

Thomas Tailly ◽

BEN H CHEW ◽

Naeem Bhojani ◽

R. Daron Smith

Keyword(s):

Consensus Statement ◽

Urinary Stone ◽

Delphi Process ◽

Research Initiative ◽

Stone Treatment

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Impact of ureteral access sheath on renal stone treatment: prospective comparative non-randomised outcomes over a 7-year period

World Journal of Urology ◽

10.1007/s00345-019-02878-5 ◽

2019 ◽

Vol 38 (5) ◽

pp. 1329-1333 ◽

Cited By ~ 3

Author(s):

Ashleigh Lima ◽

Thomas Reeves ◽

Robert Geraghty ◽

Amelia Pietropaolo ◽

Lily Whitehurst ◽

...

Keyword(s):

Renal Stone ◽

Ureteral Access Sheath ◽

Access Sheath ◽

Stone Treatment

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Identification of aberrant glycosylation of osteopontin in urinary stone former patients as a urolithiasis biomarker

European Urology Supplements ◽

10.1016/s1569-9056(19)30195-2 ◽

2019 ◽

Vol 18 (1) ◽

pp. e268-e269

Author(s):

G. Anan ◽

T. Yoneyama ◽

Y. Tobisawa ◽

S. Hatakeyama ◽

M. Yoneyama ◽

...

Keyword(s):

Urinary Stone ◽

Aberrant Glycosylation ◽

Stone Former

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Sensitivity and specificity of 24-hour urine chemistry levels for detecting elevated calcium oxalate and calcium phosphate supersaturation

Canadian Urological Association Journal ◽

10.5489/cuaj.511 ◽

2013 ◽

Vol 2 (2) ◽

pp. 117 ◽

Cited By ~ 3

Author(s):

M. Adrian Rossi ◽

Eric A. Singer ◽

Dragan J. Golijanin ◽

Rebeca D. Monk ◽

Erdal Erturk ◽

...

Keyword(s):

Calcium Phosphate ◽

Calcium Oxalate ◽

Sensitivity And Specificity ◽

Retrospective Review ◽

Gold Standard ◽

Urine Analysis ◽

Stone Formation ◽

Urine Collection ◽

Total Calcium ◽

Men And Women

Objectives: The gold standard for determining likelihood of calcium oxalate(CaOx) and calcium phosphate (CaPhos) stone formation in urine is supersaturationof CaOx and CaPhos. Our objective was to investigate whether traditionalmeasurement of total calcium, oxalate and phosphate in a 24-hour urinecollection is sufficiently sensitive and specific for detecting elevated supersaturationto preclude the more expensive supersaturation test.Methods: We performed a retrospective review of 150 consecutive patients withnephrolithiasis who underwent measurement of CaOx supersaturation (CaOxSS)and CaPhos supersaturation (CaPhosSS), as well as total calcium, oxalate andphosphate in a 24-hour urine collection. We used various cut-off values to determinesensitivity and specificity of 24-hour urine measurements for detectingelevated CaOxSS and CaPhosSS.Results: In men and women, the sensitivity of 24-hour calcium for detectingelevated CaOxSS was 71% and 79%, respectively; for oxalate, sensitivity was59% and 36%, respectively. In men and women, the sensitivity of 24-hour calciumfor detecting elevated CaPhosSS was 74% and 88%, respectively; for phosphate,sensitivity was 57% and 8%, respectively. In men and women, the specificityof 24-hour calcium for detecting elevated CaOxSS was 55% and 48%,respectively; it was 60% for detecting elevated CaPhosSS in both men andwomen.Conclusion: Traditional 24-hour urine analysis is sensitive, but not specific, fordetecting elevated CaOxSS and CaPhosSS. Most patients with abnormal 24-hour urine analysis have normal supersaturation, and treatment decisions basedon traditional urine analysis would lead to overtreatment in these patients.

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Quality control in urinary stone analysis: results of 44 ring trials (1980–2001)

Clinical Chemistry and Laboratory Medicine (CCLM) ◽

10.1515/cclm.2005.051 ◽

2005 ◽

Vol 43 (3) ◽

Cited By ~ 50

Author(s):

Albrecht Hesse ◽

Rolf Kruse ◽

Wolf-Jochen Geilenkeuser ◽

Matthias Schmidt

Keyword(s):

Quality Control ◽

Infrared Spectroscopy ◽

Urinary Stone ◽

Error Rates ◽

The Body ◽

X Ray Diffraction ◽

Stone Analysis ◽

Chemical Methods ◽

X Ray ◽

Pure Substances

AbstractUrinary stone analysis is the most important diagnostic step after stone removal from the body. The methods employed for these analyses are based on diverse analytical principles. Chemical methods are used for detecting individual ions. Infrared spectroscopy is used for examining molecular structures, and X-ray diffraction for determination of the crystalline structure of a substance. Since 1980, a twice-yearly ring trials quality control survey has been on offer to examine the quality of urinary stone analyses. A summary of the results of 44 ring trials (1980–2001) has been compiled for individual pure substances and binary (two-component) mixtures. On average, 100 laboratories have participated in these ring trials. Initially, over 80% of the participants carried out their analyses using chemical methods. In 2001, this figure decreased to a mere 13%. In contrast, a progressive increase in the use of infrared spectroscopy was observed, up to 79% of all participants employed this method. X-Ray diffraction was only employed in a small number of specialised laboratories (5–9%). The chemical methods produced a very high proportion of errors (6.5–94%) with both the pure substances and binary mixtures, whereas high error rates for infrared spectroscopy and X-ray diffraction were confined to individual substances only. Due to the poor results in the ring trials, the majority of laboratories stopped using chemical analysis, which is now considered to be obsolete. Regarding mixtures, error rates of over 10% also occurred with infrared spectroscopy and X-ray diffraction. Ring trials are indispensable for the quality management of urinary stone analysis.

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