Urolithiasis in Tunisian children: a study of 100 cases

The aim of this study is to assess the clinical and biological characteristics of renal stone disease among children living in the coastal region of Tunisia. This retrospective multi-center study included 100 children under the age of 16 years, who presented with urinary stones. The patients' charts were reviewed with regard to age at diagnosis, sex, history and physical examination as well as laboratory and radiologic findings. Stone analysis was performed by infrared spectrophotometry. The male/female sex ratio was 1.5 to 1. The clinical presentation of this pathology was dominated by dysuria. Stones were located in the upper urinary tract in 76 cases (76%). A total of 13% of the study subjects had positive urine cultures. Metabolic investigations were performed in all patients and were normal in 80 cases. Whewellite (calcium oxalate) was found in 77 stones (77.0%). Stone section was made of whewellite in 69.0% of cases and ammonium urate in 47.0%. Struvite stones were more frequently seen in the lower urinary tract. Our study suggests that the epidemiological profile of renal stones in Tunisia has changed towards a predominance of calcium oxalate stones and upper tract location. Also, the male predominance of pediatric urolithiasis is becoming less obvious in Tunisia.

[The relationship between inflammatory bowel disease (IBD) and complications of urinary and male genital tracts]

Crohn's disease (CD) and ulcerative colitis (UC) are inflammatory bowel diseases (IBD) that may often involve organs other than those of the gastrointestinal tract. We investigated retrospectively the frequency, diagnosis and treatment of urinary and male genital complications of CD and UC. From February 1998 to July 2007, 93 patients with CD and 75 patients with UC consulted our department for urinary and male genital complications. Thirty, 19 and 16 of the 93 patients with CD were diagnosed as having fistulas to the urinary and male genital systems, urolithiasis and hydronephrosis, respectively. Fifteen, 14 and 13 of the 75 patients with UC were diagnosed as having urolithiasis, urinary tract infection (UTI) and lower urinary tract symptoms (LUTS), respectively. Fistula to the urinary and male genital systems in CD occurred more often in men. In 22 CD patients who had undergone surgical operation and were definitively diagnosed as fistula, the positive rate of cystogram (CG) was 38.1% (8/21). They presented with pyuria (10 cases), pneumaturia (7), hematuria (7), fecaluria (2) and urorrhea (2). Cystoscopy was performed in 20 patients. Fistula opening in the urinary bladder was found in only 2 patients. Other findings in the bladder were edema (14 cases), redness of mucosa (6) and debris (3). Hydronephrosis in CD occurred in 16 patients. Placing a percutaneus nephrostomy (PNS) or ureteral stent was performed in 11 patients and surgical therapy was performed in 12 patients. Only two of the 34 patients with urolithiasis (CD 19, UC 15 cases) underwent ESWL and/or TUL. Almost all patients with UTI in UC were treated with antibiotics and improved, but one patient died from Fournier's Gangrene due to erirectal abscess.

[Food additive urisan in combined treatment of urolithiasis]

Thirty three urolithiasis patients (13 males, 18 females aged 29-77 years, 2 children, duration of the disease 1-17 years) received food additive urisan in combined treatment of urolithiasis. Blood and urine biochemistry was studied by 11 parameters to evaluate renal function and lithogenesis before and after intake of urisan. Standard treatment was combined with intake of 2 capsules (1100 mg) of urisan twice a day at meal for 2-3 weeks. The data were processed statistically. It is shown that urisan contributes to intensification of renal filtration function, to reduction of hyperuricemia and urine pH, intensification of uric acid excretion, continuation of inflammation remission, attenuation of proteinurea in urolithiasis patients with exacerbation of chronic pyelonephritis.

[Successful combined surgical treatment double giant ureterocele complicated by double ureterohydronephrosis, cascade lithiasis and uterine myomatosis]

A case is reported of a 58 year old patient with a diagnosis: double giant ureterocele, secondary multiple calculi of the right ureterocele, calculus of the inferior calyx of the right kidney, calculus of the terminal part of the left ureter, double ureterohydronephrosis, chronic pyelonephritis, multiple calcifying myoma of the uterus. A combined single-stage operation (panhysterectomy, deletion of multiple calculi of the right ureterocele, deletion of the calculus of the left ureterocele, crosscut right ureterectomy with excision of ureterocele, right ureterocystoneostomy by Leadbetter-Politano, installation of the double J-stent into the right kidney, crosscut and longitudinal left ureterectomy with excision of ureterocele, left ureterocystoneostomy by Leadbetter-Politano, installation of intubating drainage into the left ureter, cystostomy) followed by extracorporeal shock-wave lithotripsy were performed in this adult patient with combined pathology of the urinary system.

Chronic renal failure in Sudanese children: aetiology and outcomes

The provision of tertiary paediatric nephrology facilities has led to increasing referrals of children with chronic renal failure (CRF). We report the aetiology and outcomes over 5 years, during which period the improving socio-economic situation has allowed increasing provision of dialysis and transplantation. The records of 205 children (124 male; 60.5%) who were referred to a tertiary paediatric nephrology unit in Khartoum between 2001 and 2006 with a glomerular filtration rate of less than 50 ml/min per 1.73 m(2) body surface area were reviewed. The mean age at the time of diagnosis with CRF was 9.8 years (range 3 months-17 years). The aetiology was chronic glomerulonephritis in 52 (25.4%), congenital urological malformations in 36 (17.5%), urolithiasis in 19 (9.3%), hereditary nephropathy in 14 (6.8%), multisystem diseases in 4 (2%), and cause unknown in 80 (39.1%). Of the 205 children, 136 (63%) had reached end-stage renal failure, with chronic haemodialysis being undertaken in 48 (35.3%), intermittent peritoneal dialysis in 43 (31.6%), continuous ambulatory peritoneal dialysis in 17 (14.7%), and no treatment in 25 (18.4%). At the end of the study period 53 of the 205 (25.9%) remained on dialysis, 51 (25%) were on conservative treatment, 8 (3.9%) had received transplants, 48 (23.4%) had died, and 45 (22%) had been lost to follow-up. The results illustrate the geographical variations in CRF aetiology in different countries, which may be influenced by current patterns of referral as well as environmental and society factors. The large number with an unknown aetiology for their CRF requires further prospective investigation. We hope the current high mortality rate will improve with earlier referral, improved nutrition, family support, and better access to treatment modalities, especially the provision of kidney transplantation from living related donors.

[Antibacterial therapy of patients with urolithiasis: efficacy and safety]

Retrospective analysis provided data on the efficacy and safety of antimicrobial therapy in the treatment of urinary tract infections in 21 patients with urolithiasis in an urological unit of a municipal multiprofile hospital. For estimation of the antimicrobial therapy efficacy ATC/DDD method was used (The Anatomical Therapeutic Chemical Classification System with Defined Daily Doses). The analysis showed that the isolates (> 50%) were highly resistant to the majority of the antibiotics prescribed by the physicians for the empirical therapy within 90% DU (Drug Utilization). Moreover, adverse reactions to the antibiotics were recorded in 9.5% of the patients. It was concluded that in the routine practice of the physicians, the antibiotic therapy was not corrected with the microbiological view and the pharmacotherapy efficacy was not duely estimated. Such a situation requires cooperation of clinical pharmacologists and clinicians, periodical analysis of the drug misuse and therapeutic drug monitoring to solve the problem.

[Summary of the practice guideline 'Urolithiasis' (first revision) from the Dutch College of General Practitioners]

The Dutch College of General Practitioners has revised the practice guideline 'Urolithiasis'. In the acute phase, violent colic pain is treated with diclophenac or morphine. In the post-acute phase, imaging diagnostics are performed. Initially this is ultrasound examination and, ifindicated, an x-ray of the abdomen and at a later stage, a CT scan. The recommendation to consider the use oftamsulosin in the post acute phase is new. This alpha-1 blocking agent can enhance expulsion of the stone and contribute to the relief of pain.

Review of paediatric patients with urolithiasis, in view of development of urinary tract infection

OBJECTIVE

To assess the development of UTI in paediatric patients, presented to OPD with urolithiasis. To ascertain what general parameters are associated with UTI, and examine specific characteristics of the calculi.

METHOD

It was a retrospective study. Files of paediatric patients from July 2000 to December 2004 were reviewed. Only those patients with calculi and absent UTI and upto 5 years age were studied. All files of patients, primarily presenting with UTI, and those with documented urological procedures prior to UTI occurrence, were excluded from the study. Ultrasound and X-ray techniques were used to determine stone size and location. Collected urine samples were screened for UTI; organisms were isolated and cultured using Cystine Lactose Electrolyte Deficient (CLED) culture medium.

RESULT

A total of 149 patients were studied. The mean age was 3.05 +/- 1.25 years, [77.2 %] were males [22.8%] females. Urinary tract infection [UTI] was found in 37.6% cases. Age status was significantly associated with UTI [p=0.008] along with the anatomical location [p=0.021]. The most common organism found on our culture plate of UTI positive patients was E. coli (21.4%). Bacteria were most sensitive to aminoglycoside group [16%] of antibiotics.

CONCLUSION

We found a significant association between age, anatomical location of stones and UTI. These factors should be considered in paediatric patients to prevent UTI and its complications.

Hematuria: etiology and evaluation for the primary care physician

Asymptomatic microscopic and gross hematuria are common problems for the primary care physician. The exact definition of microscopic hematuria is debated, but is defined by one group as > 3 red blood cells/high power microscopic field. While the causes of hematuria are extensive, the most common differential diagnosis for both microscopic and gross hematuria in adults includes infection, malignancy, and urolithiasis. Clinical evaluation of these patients often involves urological consultation with urine cytology, urine culture, imaging studies, and cystoscopy. Patients who have no identifiable cause after an extensive workup should be monitored for early detection of malignancy or occult renal disease.

[Treatment of the patients with urolithiasis combined with benign prostatic hypertrophy]

Treatment results of 368 patients with urolithiasis combined with benign prostatic hypertrophy were analyzed. Choice of treatment method depended on age, clinical symptoms, localization, size and density of concretion, dysuria symptoms, intercurrent diseases, risk of complications. Distant lithotripsy was performed at 59% cases, percutaneous nephrolithotripsy and contact uretherolithotripsy - at 10.3%, combined methods of treatment - at 2.4% cases. Mini-invasive methods of treatment led to reduction of number of traditional open operation to 1.6%. There was no one open adenomectomy during last 6 years.

[Immunological indices in urolithiasis patients with secondary pyelonephritis]

The immunological status was studied in 335 patients with urolithiasis and pyelonephritis. The techniques used for assessment of the immunological status provided a multifactorial control over immune system function in inflammation and urolithiasis: registered a significant rise of the level of proinflammatory and anti-inflammatory mediators of the immune response (IL-1beta, IL-4, IL-6, TNF), of neutrophil metabolic activity with parallel suppression of neutrophil phagocytic and absorbing functions, inhibition of bactericidal activity of the serum, a significant fall in the number of mature T-lymphocytes (CD3+) and T-helpers (CD4+). The immune status indices in urolithiasis patients with secondary pyelonephritis are closely linked with clinico-laboratory manifestations of the inflammatory process and renal function. Thus, the results of the study give grounds for developing indications for use of immunomodulating drugs in patients with secondary pyelonephritis associated with urolithiasis.

Three cases of urolithiasis associated with sarcoidosis: A review of Japanese cases

We report three cases of urolithiasis associated with sarcoidosis and reviewed the Japanese published reports. All cases had hypercalcemia, hyperuricemia, hypercalciuria and renal dysfunction. A serum level of 1,25-(OH)2D3 was elevated and intact parathyroid hormone (PTH) was decreased. Stone components were predominantly calcium oxalate. Abnormal calcium metabolism is a well-known feature of sarcoidosis and the reported prevalence of urolithiasis in patients with sarcoidosis was 1.3-14.0% in the English published reports. However, urolithiasis associated with sarcoidosis is uncommon in Japan and we could find only 16 documented cases including ours. Abnormal calcium metabolism is caused by an increase in serum concentration of 1,25-(OH)2D3, which is derived from endogenous overproduction in the pulmonary macrophages. If patients with urolithiasis have abnormal calcium metabolism, renal impairment and suppression of PTH, the possibility of sarcoidosis should be considered for a differential diagnosis. Also, it should be emphasized that the presence or developing of urolithiasis is to be monitored during follow up of patients with sarcoidosis.

Urolithiasis in pediatric patients: a single center study of incidence, clinical presentation and outcome

PURPOSE

The incidence of kidney stones in adults has increased in the last 30 years. This retrospective, single site review was done to test the hypotheses that the incidence of urolithiasis in pediatric patients increased from 1994 to 2005, and that metabolic abnormalities were more common in patients with renal stones in the final 3 years of the study period.

MATERIALS AND METHODS

Charts from 2 time periods were reviewed, 1994 to 1996 (period 1) and 2003 to 2005 (period 2). Clinical and laboratory data, including demographics, presenting complaints, laboratory assessment, treatment and outcome, were tabulated in patients with confirmed urolithiasis.

RESULTS

The number of patients with urolithiasis increased from 7 in period 1 to 61 in period 2. When expressed as cases per 100 new patients the incidence increased 4.6 times (p = 0.014). Focusing on period 2, 28% of patients were younger than 10 years. While blood tests were generally normal, 76% of patients had at least 1 abnormality in the 24-hour urine collection. Hypocitraturia, which was the most common metabolic abnormality, was noted in 52% of patients. The small number of patients in period 1 precluded determination as to whether metabolic abnormalities were more common in period 2. Surgery and/or lithotripsy was required in 12 children. Stone disease recurred in 39% of the patients.

CONCLUSIONS

The incidence of urolithiasis in the pediatric population increased nearly 5-fold at our institution during the last decade. We recommend that the primary diagnostic test be a 24-hour urine collection. The most common metabolic abnormality was hypocitraturia, followed by hypercalciuria. Recurrence of stones is common (approximately 40% rate) and followup is advised.

Management of urolithiasis with chronic renal failure

PURPOSE OF REVIEW

Epidemiological trends of urolithiasis and the prevalence of renal failure in patients with stones have changed. This is the era of minimally invasive therapy for stone disease. We review the impact of minimally invasive therapy on the management of urolithiasis in patients with renal failure and its outcome.

RECENT FINDINGS

The prevalence of urolithiasis has reached its peak and plateaued in Europe and North America while it is still rising in the underdeveloped countries. The prevalence of renal failure in patients with chronic renal failure has reduced by half over the last decade. Minimally invasive therapy like percutaneous nephrolithotripsy has fared better than open stone surgery in all respects. Patients with kidney stones do not have normal renal function. Recently, cystine stones, and stones in patients with renal tubular acidosis and bowel disease were shown to affect renal function significantly.

SUMMARY

Management of stones in chronic renal failure is challenging. Efforts should be made to minimize renal injury. Once a 'stone-free' kidney is achieved, steps should be taken to conserve renal function and address the issue of recurrence.

[Retroperitoneoscopic ureterolithotomy]

Ureterolithotomy has an alternative which is much less invasive --retroperitoneoscopic ureterolithotomy (RU). Nineteen cases of RU are reported (15 males, 4 females). Thirteen patients have undergone RU as monotherapy, 5 patients--after ineffective sessions of extracorporeal shock wave lithotripsy, 1 patient--after contact ureterolithotripsy. Mean size of the stones was 12.8 (9.5-30) mm. All the stones were eliminated for one procedure. Duration of surgery in the first 5 operations was 1.5-2 hours, in subsequent ones--65-70 min. The number of bed-days varied from 2 to 10 days (4.2 days). One male had a postoperative attack of pyelonephritis which was treated with antibacterial drugs. RU is a safe and effective operation, it is justified when previous surgery was ineffective, in large, longstanding concrements of the upper and middle third of the ureter, monohydrate-oxalate concrements.

Acute renal failure due to bilateral uric acid lithiasis in infants

Acute renal failure (ARF) is one of the complications of urolithiasis, but the role of medical treatment to relieve urinary obstruction in children with ARF is uncertain. We report on infants with acute obstructive uric acid lithiasis. We describe presentation features as well as diagnosis methods and medical treatment in five infants who were admitted to our institution with ARF due to uric acid lithiasis. The medical treatments for all patients were fluid liberalization, urine alkalinization, and oral allopurinol. Two children underwent urinary diversion. Within 8 h, urine output improved in all patients, and the stones passed spontaneously. All obstructed kidneys were relieved with medical treatment, and no renal sequel remained. So this series has showed a role of medical therapy in acute obstructive uric acid lithiasis.

[Urodynamics of the upper urinary tract in urolithiasis patients with chronic pyelonephritis]

Urodynamics was studied in patients with chronic pyelonephritis with a various level of upper urinary tract (UUT) obstruction. 90% patients with concrements of the low ureter had high intrapelvic pressure (IPP)--21.8 +/- 0.8/25.2 +/- 0.8 cm of water column (basal/peristaltic) and enhanced UUT contractility. IPP was elevated in 50% patients with proximal UUT obstruction (11.8 +/- 1.3/15.5 +/- 1.5 cm of water column) and it rose noticeably (by 110-184%) in changing body position (orthostatic test) but changed little in the respiratory test. High IPP persisted despite functioning nephrostomic drainages in 84-86% patients exposed to extracorporeal and/or contact lithotripsy at the average level 16.2 +/- 0.8/19.7 +/- 0.6 cm of water column. Different mechanisms may be involved in formation of high IPP in patients with chronic pyelonephritis and varying level of UUT obstruction. In view of damaging influence of high IPP on renal function the physician should control this index during the treatment and take additional measures to prevent elevation of IPP.

Management of urolithiasis in the congenitally abnormal kidney (horseshoe and ectopic)

PURPOSE OF REVIEW

Urolithiasis in horseshoe and ectopic kidneys presents unique challenges in the decision-making and technical aspects of stone treatment. Specific renal anatomy, stone size and associated conditions such as ureteropelvic junction obstruction are factors that may influence treatment. Detailed review of imaging is important to ensure efficient stone treatment and minimize complications.

RECENT FINDINGS

Widespread use of extracorporeal shockwave lithotripsy for calculi in congenitally abnormal kidneys is now giving way to stone-size and anatomy-appropriate therapeutic decision making. Multiple modalities including shockwave lithotripsy, ureteroscopy, percutaneous nephrolithotomy and laparoscopy are being employed in this group of patients.

SUMMARY

Treatment decisions for stones in horseshoe and ectopic kidneys can be challenging, and must be made on an individual basis taking into account multiple variables.

[Biliurolithiasis - a classification of a disease with complex characteristics]

The development of the medicine itself, meets the current question of the common, interdisciplinary method of approach in the treatment of a series of diseases, such as biliurolithiasis. The attempt to make a classification is basic for making an optimal method of treatment of the biliurolithiasis. The biliurolithiasis is a disease influencing some new strategies of treatment in the combined efforts of the urologist and the surgeons both.

Urolithiasis associated with bilateral pelvic diverticula: a case report

We present a case of renal stone associated with bilateral pelvic diverticula. The initial diagnosis by ultrasonography and plain abdomen radiography (KUB) was urolithiasis with a 15-mm calculus in the right renal pelvis. The patient was referred for extracorporeal shock wave lithotripsy, but no stone fragments were yielded. So, further evaluations were performed by using repeated ultrasonography, intravenous urography, and computerized tomography, which revealed the presence of diverticula in both right and left renal pelvises with stone fragments within the right sided diverticulum. We concluded that intravenous urography and contrast-enhanced computerized tomography are essential for confirmation of diagnosis when ultrasonographic findings suggest the presence of renal cystic lesions, or when stone fragments are not yielded after extracorporeal shock wave lithotripsy.

Urolithiasis and psoas abscess in a 2-year-old boy with type 1 glycogen storage disease

We report on a pyogenic psoas abscess secondary to an impacted calcium oxalate ureteric stone in a 2-year-old boy with glycogen storage disease type 1 (GSD-1). The patient had a drainage of the abscess through a flank incision followed by percutaneous nephrostomy and open ureterolithotomy. Metabolic acidosis, hyperuricemia, hypocitraturia, and hypercalciuria appear to be significant in the pathogenesis of urolithiasis in patients with GSD-1. Regular ultrasonography of the abdomen along with optimal metabolic control may delay or prevent urolithiasis and its complications in GSD-1 patients.

Urolithiasis in Pregnancy: Current Diagnosis, Treatment, and Pregnancy Complications

Urolithiasis complicates up to one in every 200 pregnancies; consequently, the practicing obstetrician should be aware of the symptoms of urolithiasis, the diagnostic procedures available for its diagnosis, and their associated risks. These include ultrasound, urography, and magnetic resonance imaging. Diagnosis of urolithiasis during pregnancy can be a challenge as a result of the normal physiological changes of pregnancy. Conservative management is the first-line treatment for noncomplicated urolithiasis in pregnancy. If spontaneous passage of the stone does not occur or if complications develop, urologic consultation should be obtained. Several obstetric complications have been associated with urolithiasis, including preterm labor and preterm premature rupture of membranes, although the reported rates of these complications in association with urolithiasis vary widely and overlap normal background rates. Given that urolithiasis will be encountered by most obstetricians, and that obstetricians are often on the front line of management for this condition, an appreciation of current diagnostic modalities, treatment protocols, and associated potential obstetric complications is warranted.

TARGET AUDIENCE

Obstetricians & Gynecologists, Family Physicians.

LEARNING OBJECTIVES

After completion of this article, the reader should be able to recall that urolithiasis is common in pregnancy, state that there are a variety of diagnostic procedures, summarize that conservative treatment is usually successful, and explain that complications of pregnancy usually occur when there is failure of conservative treatment.

Challenge of percutaneous nephrolithotomy in patients with spinal neuropathy

OBJECTIVE

To assess the technical difficulties, associated complications and stone clearance rates in patients with spinal neuropathy undergoing percutaneous nephrolithotomy.

METHODS

Twenty-nine patients with spinal neuropathy underwent percutaneous nephrolithotomy in the two centers studied between October 1995 and January 2002. They were nine patients with traumatic spinal cord injury, 10 patients with spina bifida and 10 with other heterogeneous causes for their spinal neuropathy. The group included 12 men and 17 women, with an average age of 44 years (14-80). Patients' medical records were reviewed retrospectively for data relating to their renal lithiasis.

RESULTS

A total of 39 percutaneous nephrolithotomy procedures were undertaken on 32 kidneys. Thirteen procedures were for staghorn calculi. Preoperatively, eight kidneys required nephrostomy and 5 J stent decompression. The average American Society of Anesthesiologists (ASA) score was 3, and one patient had percutaneous nephrolithotomy performed under local anaesthetic as the risk of general anaesthetic was felt to be too high. The associated morbidity and mortality in this group is significant. There were two postoperative deaths. Major complications were associated with three procedures, and consisted of seizures, aspiration pneumonia and pressure necrosis. Nine patients experienced minor complications including fever, hypotension and nephrostomy site leakage. Nine patients required intensive therapy unit care postoperatively and the average hospital stay for the group was 13.32 days. Only 18 (62%) patients were rendered stone-free from their initial percutaneous nephrolithotomy. Seven patients required a further procedure for stone clearance: four underwent extracorporeal shock-wave lithotripsy, two ureteroscopy and one nephrectomy.

CONCLUSIONS

Patients with spinal neuropathy and renal lithiasis pose a significant operative challenge. Technical difficulties and potential complications should be considered carefully before undertaking percutaneous nephrolithotomy in these patients.

Renal colic--radiological approach

Acute flank pain is commonly caused by urolithiasis. This paper discusses advantages and disadvantages of procedures used for evaluation of acute flank pain. In our institution, the diagnostic algorithm includes ultrasonography and plain film radiography, and unenhanced spiral CT in equivocal cases.

Acute renal failure due to bilateral xanthine urolithiasis in a boy with Lesch-Nyhan syndrome

Lesch-Nyhan syndrome is a very rare X-linked recessive disorder caused by mutation in the gene encoding enzyme hypoxanthine-guanine phosphoribosyltransferase (HPRT). A complete deficiency of HPRT leads to severe purine overproduction and to uric acid renal lithiasis as a consequence. This may be effectively prevented by administration of allopurinol; however, its overdosage may result in xanthinuria and xanthine urolithiasis. We report on a 9-year-old boy with Lesch-Nyhan syndrome who developed acute renal failure due to bilateral staghorn xanthine urolithiasis resulting from long-term treatment with excessive doses of allopurinol. To the best of our knowledge, the presented case is the first one in the literature.

Bone and stone in ankylosing spondylitis: osteoporosis and urolithiasis

Ankylosing spondylitis (AS) has well-defined renal complications, but urolithiasis has not been studied in detail. We aimed to evaluate the relation between AS and urolithiasis presence and the effect of this coexistence on the bone mineral status of patients. By dual-energy x-ray absorptiometry measurements at the femoral neck and lumbar vertebrae, we assessed the influence of urolithiasis, disease activity, and duration on bone mineral density (BMD) at different sites. Fifty-three AS patients and 25 control subjects were enrolled in the study. Mean age was 39.49+/-13.01 years for the AS group and 43.80+/-10.69 years for the control group, with no statistically significant difference. Patients were accepted as having active disease if two of the following were present: (1) symptomatic peripheral arthritis, (2) erythrocyte sedimentation rate greater than 30 mm/h, (3) C-reactive protein greater than 5 mg/L, and (4) dorsal-lumbar morning stiffness more than 60 min. The ratios of urinary stone presence were 11.32 and 12% for AS and control groups, respectively. We observed that a statistically significant difference in femur neck BMD between AS patients with or without urolithiasis was apparent. The lumbar BMD values were also lower in the urolithiasis subgroup but could not reach the statistical significance. There were no significant BMD alterations in the control group due to stone presence. Comparison of active-inactive disease groups revealed significantly low T scores in either the femur neck or L2-4 regions of patients with higher activity indices, but this difference was more prominent in the femur neck. In the early AS group (23 patients), 18 patients (78.26%) had L2-4 T scores lower than -1 SD, and in the advanced AS population, 19 of 30 patients (63.33%) had either osteopenia or osteoporosis (OP). We conclude that severe disease and concomitant urolithiasis might increase bone loss and fracture risk especially at the femur neck.