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Akouris PP, Chmiel JA, Stuivenberg GA, Kiattiburut W, Bjazevic J, Razvi H, Grohe B, Goldberg HA, Burton JP, Al KF. Osteopontin phosphopeptide mitigates calcium oxalate stone formation in a Drosophila melanogaster model. Urolithiasis 2022; 51:19. [PMID: 36547746 DOI: 10.1007/s00240-022-01395-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022]
Abstract
Kidney stone disease affects nearly one in ten individuals and places a significant economic strain on global healthcare systems. Despite the high frequency of stones within the population, effective preventative strategies are lacking and disease prevalence continues to rise. Osteopontin (OPN) is a urinary protein that can inhibit the formation of renal calculi in vitro. However, the efficacy of OPN in vivo has yet to be determined. Using an established Drosophila melanogaster model of calcium oxalate urolithiasis, we demonstrated that a 16-residue synthetic OPN phosphopeptide effectively reduced stone burden in vivo. Oral supplementation with this peptide altered crystal morphology of calcium oxalate monohydrate (COM) in a similar manner to previous in vitro studies, and the presence of the OPN phosphopeptide during COM formation and adhesion significantly reduced crystal attachment to mammalian kidney cells. Altogether, this study is the first to show that an OPN phosphopeptide can directly mitigate calcium oxalate urolithiasis formation in vivo by modulating crystal morphology. These findings suggest that OPN supplementation is a promising therapeutic approach and may be clinically useful in the management of urolithiasis in humans.
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Affiliation(s)
- Polycronis P Akouris
- Canadian Centre for Human Microbiome and Probiotics, London, ON, Canada
- Department of Microbiology and Immunology, Western University, London, ON, Canada
| | - John A Chmiel
- Canadian Centre for Human Microbiome and Probiotics, London, ON, Canada
- Department of Microbiology and Immunology, Western University, London, ON, Canada
| | - Gerrit A Stuivenberg
- Canadian Centre for Human Microbiome and Probiotics, London, ON, Canada
- Department of Microbiology and Immunology, Western University, London, ON, Canada
| | - Wongsakorn Kiattiburut
- Canadian Centre for Human Microbiome and Probiotics, London, ON, Canada
- Department of Microbiology and Immunology, Western University, London, ON, Canada
| | - Jennifer Bjazevic
- Division of Urology, Department of Surgery, Western University, London, ON, Canada
| | - Hassan Razvi
- Division of Urology, Department of Surgery, Western University, London, ON, Canada
| | - Bernd Grohe
- Canadian Centre for Human Microbiome and Probiotics, London, ON, Canada
| | - Harvey A Goldberg
- Department of Biochemistry, Western University, London, ON, Canada
- School of Dentistry, Western University, London, ON, Canada
| | - Jeremy P Burton
- Canadian Centre for Human Microbiome and Probiotics, London, ON, Canada
- Department of Microbiology and Immunology, Western University, London, ON, Canada
- Division of Urology, Department of Surgery, Western University, London, ON, Canada
| | - Kait F Al
- Canadian Centre for Human Microbiome and Probiotics, London, ON, Canada.
- Department of Microbiology and Immunology, Western University, London, ON, Canada.
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Thakur APS, Sharma V, Ramasamy V, Choudhary A, Patel P, Singh S, Parol S. Management of ureteric stone in pregnancy: a review. AFRICAN JOURNAL OF UROLOGY 2020. [DOI: 10.1186/s12301-020-00070-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Urolithiasis in pregnancy is a major health concern and is one of the most common causes for non-obstetrical abdominal pain and subsequent hospital admission during pregnancy. The incidence of urinary calculi during pregnancy varies in the range of 1/200 to 1/2000. Acute ureteric colic in pregnancy is associated with significant potential risks to both mother and fetus. Significant anatomic and functional changes occur in pregnancy which not only lead to stone formation but also create diagnostic dilemma. The diagnosis of ureteric calculi can be incorrect in about 28% of pregnant patients.
Main body
Management of ureteric stone during pregnancy is remaining to be a challenge for the treating urologist. Because of the inability to use good imaging options for the diagnosis confirmation and more invasive approach for the treatment, management continues to be difficult. The main threats are preterm labor with delivery and premature rupture of membranes. Other pregnancy complications are obstructive uropathy, gestational diabetes mellitus, recurrent abortions and pre-eclampsia. Management of diagnosed ureteric stone is unique in the pregnant population and requires multi-disciplinary care. It should be individualized for each patient and moves preferably from conservative to invasive approaches sequentially. With continued advancements in endourological techniques, few definitive treatment options are also available for such patients.
Conclusion
There are several lacunae related with the diagnostic imaging, medical expulsive therapy, reliability of ureteral stent/percutaneous nephrostomy insertions and safety of ureteroscopy during pregnancy. Herein, we review the management of ureteric stone during pregnancy, the various diagnostic modalities and treatment options with their advantages and disadvantages. We also proposed our management algorithm to deal with such clinical scenario in this particular population.
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Li H, Shkolyar E, Wang J, Conti S, Pao AC, Liao JC, Wong TS, Wong PK. SLIPS-LAB-A bioinspired bioanalysis system for metabolic evaluation of urinary stone disease. SCIENCE ADVANCES 2020; 6:eaba8535. [PMID: 32494753 PMCID: PMC7244315 DOI: 10.1126/sciadv.aba8535] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 03/18/2020] [Indexed: 05/21/2023]
Abstract
Urinary stone disease is among the most common medical conditions. Standard evaluation of urinary stone disease involves a metabolic workup of stone formers based on measurement of minerals and solutes excreted in 24-hour urine samples. Nevertheless, 24-hour urine testing is slow, expensive, and inconvenient for patients, which has hindered widespread adoption in clinical practice. Here, we demonstrate SLIPS-LAB (Slippery Liquid-Infused Porous Surface Laboratory), a droplet-based bioanalysis system, for rapid measurement of urinary stone-associated analytes. The ultra-repellent and antifouling properties of SLIPS, which is a biologically inspired surface technology, allow autonomous liquid handling and manipulation of physiological samples without complicated sample preparation procedures and supporting equipment. We pilot a study that examines key urinary analytes in clinical samples from patients with urinary stone. The simplicity and speed of SLIPS-LAB hold the potential to provide actionable diagnostic information for patients with urinary stone disease and rapid feedback for responses to dietary and pharmacologic treatments.
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Affiliation(s)
- Hui Li
- Department of Biomedical Engineering, The Pennsylvania State University, University Park, PA, USA
| | - Eugene Shkolyar
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA
| | - Jing Wang
- Department of Mechanical Engineering, The Pennsylvania State University, University Park, PA, USA
- Materials Research Institute, The Pennsylvania State University, University Park, PA, USA
| | - Simon Conti
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Alan C. Pao
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Joseph C. Liao
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Tak-Sing Wong
- Department of Biomedical Engineering, The Pennsylvania State University, University Park, PA, USA
- Department of Mechanical Engineering, The Pennsylvania State University, University Park, PA, USA
- Materials Research Institute, The Pennsylvania State University, University Park, PA, USA
| | - Pak Kin Wong
- Department of Biomedical Engineering, The Pennsylvania State University, University Park, PA, USA
- Department of Mechanical Engineering, The Pennsylvania State University, University Park, PA, USA
- Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
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Educational review: role of the pediatric nephrologists in the work-up and management of kidney stones. Pediatr Nephrol 2020; 35:383-397. [PMID: 30607567 DOI: 10.1007/s00467-018-4179-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 10/23/2018] [Accepted: 12/13/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND The incidence of nephrolithiasis in children and adolescents is increasing and appears to double every 10 years. The most important role of the pediatric nephrologist is to diagnose and modify various metabolic and non-metabolic risk factors, as well as prevent long-term complications especially in the case of recurrent nephrolithiasis. OBJECTIVE The purpose of this review is to summarize the existing literature on the etiology and management of pediatric nephrolithiasis. RESULTS The incidence of kidney stones is increasing; dietary and environmental factors are probably the main causes for this increased incidence. In most pediatric patients, the etiology for the kidney stones can be identified. Metabolic factors, such as hypercalciuria and hypocitraturia, urinary tract infection, and urinary stasis, constitute leading causes. Herein, we review the etiologies, diagnostic work-up, and treatment options for the most prevalent causes of kidney stones. The detrimental effects of excessive dietary sodium, reduced fluid intake, and the benefits of plant-based over animal-based protein consumption on urinary crystal formation are discussed. We also review the long-term complications. CONCLUSIONS Pediatric nephrologists have an important role in the diagnostic work-up and prevention of recurring nephrolithiasis.
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Rezaee ME, Rule AD, Pais VM. What are the main challenges to the pharmacological management of cystinuria? Expert Opin Pharmacother 2019; 21:131-133. [PMID: 31724887 DOI: 10.1080/14656566.2019.1691522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Michael E Rezaee
- Section of Urology, Department of Surgery, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH, USA
| | - Andrew D Rule
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA.,Division of Epidemiology, Mayo Clinic, Rochester, MN, USA
| | - Vernon M Pais
- Section of Urology, Department of Surgery, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH, USA
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Arslan IE, Kilicarslan H, Cicek MC, Gunseren KO, Ocakoglu G, Kaygısız O. Determination of urinary stone composition using biochemical analysis of fluid samples taken during ureterorenoscopic laser lithotripsy. Int Urol Nephrol 2019; 51:1941-1947. [PMID: 31346972 DOI: 10.1007/s11255-019-02238-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 07/16/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE The present study aims to biochemically analyze the fluid samples containing stone dust taken during the perioperative period to determine the role of fluid in the prediction of stones in patients treated with ureterorenoscopic procedures. Our secondary aim is to investigate the role of both fluid analysis and stone analysis in predicting the results of the metabolic analysis. METHODS Comparative analyses were performed using fluid samples containing stone dust from 93 patients. Biochemical analysis of fluid containing stone dust was conducted; stone fragments were examined at a separate location using X-ray diffractometry(XRD). Metabolic analysis was performed to patients who provided stone-free status 1 month later. The results of chemical analysis were compared with the results of the XRD analysis. RESULTS Patients' stone type was determined with high accuracy using biochemical analysis. Differences were noted in ten patients following biochemical analysis and XRD analysis. Biochemical analysis predicted metabolic disorders in more patients than XRD analysis, particularly for those patients with multiple stone compositions. However, no significant differences between the results of biochemical and XRD analysis methods were found (κ = 0.27; p = 0.002). Moreover, biochemical analysis results revealed metabolic disorders in five patients; these findings were missed by XRD analysis. CONCLUSION Biochemical analysis of fluid taken perioperatively during ureterorenoscopic laser lithotripsy to treat urinary system stone disease was found to determine stone composition with high accuracy. Biochemical analysis of fluid samples taken during the perioperative period is, thus, an easy, reliable and cost-effective test to assess stone composition in patients undergoing ureterorenoscopic procedures.
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Affiliation(s)
- I Ethem Arslan
- Department of Urology, Uludag University, Bursa, Turkey.
| | | | | | | | - Gokhan Ocakoglu
- Department of Biostatistics, Uludag University, Bursa, Turkey
| | - Onur Kaygısız
- Department of Urology, Uludag University, Bursa, Turkey
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Noureldin YA, da Silva A, Fahmy N, Andonian S. Is it safe to prescribe ascorbic acid for urinary acidification in stone-forming patients with alkaline urine? Turk J Urol 2017; 43:183-188. [PMID: 28717544 DOI: 10.5152/tud.2017.02700] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 11/29/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To study the effect of ascorbic acid (AA) supplementation on urinary pH, metabolic stone workup parameters, and development of de novo urolithiasis in stone-forming patients. MATERIAL AND METHODS A retrospective review of the patients followed-up at a tertiary stone centre between September 2009 and October 2015 was performed. Patients with recurrent urolithiasis who received AA supplementation as a urinary acidifying agent were included in the study. Detailed metabolic stone work-up, including two 24-hour urine collections obtained pre- and post-AA supplementation were compared. In addition, imaging studies were reviewed to assess the development of de novo urolithiasis. RESULTS Twenty-four patients were included in the study with a mean age of 60.6 years and a median daily AA dose of 1000 mg (range: 500-2000 mg). Median follow-up period was 22.6 months (range: 19.7-32.1). After AA supplementation, there was a significant decrease in urinary pH (7.6 vs. 6.9, p=0.02). Although there was no significant increase in the daily oxalate excretion, two patients (8.3%) had their AA dose reduced or discontinued due to de novo hyperoxaluria (342.9 vs 510.2 umol/day; p=0.75). Other serum and urinary parameters did not show any significant changes. Eight (33.3%) patients developed de novo urolithiasis with struvite and carbonate apatite being the major components. CONCLUSION AA supplementation resulted in significantly lower urinary pH in patients with recurrent urolithiasis and alkaline urine pH. Prospective studies are needed to assess whether this reduction in urinary pH is associated with lower stone recurrence rates.
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Affiliation(s)
- Yasser A Noureldin
- Division of Urology, McGill University Health Center, McGill University, Montréal, QC, Canada.,Department of Urology, Benha University Hospital, Benha University, Benha, Egypt
| | - Alexandrine da Silva
- Division of Urology, McGill University Health Center, McGill University, Montréal, QC, Canada
| | - Nader Fahmy
- Division of Urology, McGill University Health Center, McGill University, Montréal, QC, Canada
| | - Sero Andonian
- Division of Urology, McGill University Health Center, McGill University, Montréal, QC, Canada
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[The most important current guideline recommendations on the topic urolithiasis : A brief comparison]. Urologe A 2016; 55:1302-1308. [PMID: 27663857 DOI: 10.1007/s00120-016-0235-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
For the development of patient-specific therapies the guidelines offer the physician a valuable catalogue of possible treatment options. They are based on the current level of knowledge and urological research, but also let some space for individual treatment at the same time. In this article, the current guidelines of several urological associations on the topic of urolithiasis regarding recommendations are described and the differences are highlighted.
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Ordon M, Andonian S, Blew B, Schuler T, Chew B, Pace KT. CUA Guideline: Management of ureteral calculi. Can Urol Assoc J 2015; 9:E837-51. [PMID: 26788233 DOI: 10.5489/cuaj.3483] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
The focus of this guideline is the management of ureteral stones. Specifically, the topics covered include: conservative management, medical expulsive therapy, active intervention with either shockwave lithotripsy (SWL) or ureteroscopy (URS), factors affecting SWL treatment success, optimizing success, and special considerations (e.g., pregnancy, urinary diversion). By performing extensive literature reviews for each topic evaluated, we have generated an evidence-based consensus on the management of ureteral stones. The objective of this guideline is to help standardize the treatment of ureteral stones to optimize treatment outcomes.
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Affiliation(s)
- Michael Ordon
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON
| | - Sero Andonian
- Division of Urology, Department of Surgery, McGill University, Montreal, QC
| | - Brian Blew
- Division of Urology, Department of Surgery, University of Ottawa, Ottawa, ON
| | - Trevor Schuler
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, AB
| | - Ben Chew
- Department of Urology, University of British Columbia, Vancouver, BC
| | - Kenneth T Pace
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON
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Hesswani C, Noureldin YA, Elkoushy MA, Andonian S. Combined vitamin D and calcium supplementation in vitamin D inadequate patients with urolithiasis: Impact on hypercalciuria and de novo stone formation. Can Urol Assoc J 2015; 9:403-8. [PMID: 26788229 DOI: 10.5489/cuaj.3332] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We examined the effect of combined vitamin D and calcium supplementation (VDCS) on urinary calcium excretion and de novo stone formation in vitamin D inadequate (VDI) urolithiasis patients. METHODS We retrospectively reviewed the data of VDI patients (serum 25-hydroxyvitamin D <75 nmol/L) followed at a tertiary stone centre between September 2009 and December 2014. VDI patients with history of urolithiasis, who were placed on VDCS for abnormal bone mineral density or hyperoxaluria, were included. Hypercalciuric patients and patients on thiazide diuretics were excluded. Metabolic stone workup and two 24-hour urine collections were performed before and after VDCS. RESULTS In total, we included 34 patients, with a mean age of 54.8 years and a mean body mass index of 25.7 kg/m(2). After VDCS, there was a significant increase in the mean serum 25-hydroxyvitamin D (52.0 vs. 66.4 nmol/L, p < 0.001) and the mean urinary calcium excretion (3.80 vs. 5.64 mmol/d, p < 0.001). Eight (23.5%) patients developed de novo hypercalciuria. After a median follow-up of 39 (range: 7-60) months, 50% of hypercalciuric patients developed stones compared with 11.5% of non-hypercalciuric patients (p = 0.038). CONCLUSION This study showed a significant effect of combined VDCS on mean urinary calcium excretion, de novo hypercalciuria, and stone development in VDI patients with history of urolithiasis. Therefore, VDI urolithiasis patients receiving VDCS are advised to have monitoring with 24-hour urine collections and imaging studies. Although small, our sample size was good enough to validate the statistical outcomes. Prospective studies are needed to confirm these results.
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Affiliation(s)
- Charles Hesswani
- Division of Urology, McGill University Health Centre, McGill University, Montreal, QC
| | - Yasser A Noureldin
- Division of Urology, McGill University Health Centre, McGill University, Montreal, QC;; Department of Urology, Benha University Hospital, Benha University, Benha, Egypt
| | - Mohamed A Elkoushy
- Division of Urology, McGill University Health Centre, McGill University, Montreal, QC;; Department of Urology, Suez Canal University, Ismailia, Egypt
| | - Sero Andonian
- Division of Urology, McGill University Health Centre, McGill University, Montreal, QC
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Alruwaily AF, Dauw CA, Bierlein MJ, Asplin JR, Ghani KR, Wolf JS, Hollingsworth JM. Geographic Variation in the Quality of Secondary Prevention for Nephrolithiasis. Urology 2015. [DOI: 10.1016/j.urology.2015.05.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bos D, Abara E, Parmar MS. Knowledge, attitudes, and practice patterns among healthcare providers in the prevention of recurrent kidney stones in Northern Ontario. Can Urol Assoc J 2014; 8:E795-804. [PMID: 25485006 DOI: 10.5489/cuaj.1455] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTON Kidney stone recurrence is common. Preventive measures can lead to improved quality of life and costs savings to the individual and healthcare system. Guidelines to prevent recurrent kidney stones are published by various urological societies. Adherence to guidelines amongst healthcare professionals in general is poor, while adherence to preventive management guidelines regarding stone disease is unknown. To understand this issue, we conducted an online study to assess the knowledge, attitudes, and practice patterns of healthcare practitioners in Northern Ontario. METHODS We used the database of healthcare providers affiliated with the Northern Ontario School of Medicine, in Sudbury (East Campus) and Thunder Bay (West Campus), Ontario. We designed the survey based on current best practice guidelines for the management of recurrent kidney stones. Questions covered 3 domains: knowledge, attitudes, and practice patterns. Demographic data were also collected. The survey was distributed electronically to all participants. RESULTS A total of 68 healthcare providers completed the survey. Of these, most were primary care physicians (72%). To keep uniformity, we analyzed the data of this homogenous group. A total of 70% of the respondents were aware of the current guidelines; however, only 43% applied their knowledge in clinical practice. Most participants lacked confidence while answering most items in the attitude domain. CONCLUSIONS Most primary care physician respondents were aware of the appropriate preventive measures for recurrent kidney stones; however, they do not appear to apply this knowledge effectively in clinical practice. A low response rate is a limitation of our study. Further studies involving a larger sample size may lead to information sharing and collaborative care among healthcare providers.
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Affiliation(s)
- Derek Bos
- Division of Urology, McMaster University, Hamilton, ON
| | - Emmanuel Abara
- Clinical Sciences Division, Northern Ontario School of Medicine, Sudbury, ON; and the Richmond Hill Urology Practice and Prostate Institute, Richmond Hill, ON
| | - Malvinder S Parmar
- Clinical Sciences Division, Northern Ontario School of Medicine, Sudbury, ON; and the Department of Medicine, Timmins and District Hospital, Timmins, ON
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Metabolic evaluation of urinary lithiasis: what urologists should know and do. World J Urol 2014; 33:171-8. [PMID: 25414063 DOI: 10.1007/s00345-014-1442-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 11/11/2014] [Indexed: 10/24/2022] Open
Abstract
INTRODUCTION Urolithiasis is a complex medical entity and regroups several different types of stones, each caused by a multitude of dietary imbalances or metabolic anomalies. In order to better assess the stone-forming patient, urologists should be competent in performing a thorough metabolic work-up. MATERIALS AND METHODS We reviewed the litterature in order to provide an appropriate overview of the various components of the metabolic evaluation, including stone analysis, biochemistry tests, and urine collection. CONCLUSION Performing a metabolic evaluation allows precise intervention in order to treat and mainly prevent stone disease.
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Dauw CA, Alruwaily AF, Bierlein MJ, Asplin JR, Ghani KR, Wolf JS, Hollingsworth JM. Provider variation in the quality of metabolic stone management. J Urol 2014; 193:885-90. [PMID: 25286012 DOI: 10.1016/j.juro.2014.09.111] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2014] [Indexed: 11/19/2022]
Abstract
PURPOSE Urinary stone disease is a chronic condition for which secondary prevention (dietary and medical therapy guided by 24-hour urine collection results) has an important role. Assessing the response to these interventions with followup testing is recommended and yet to our knowledge provider compliance with these guidelines is unknown. MATERIALS AND METHODS Using Litholink® files from 1995 to 2013 we identified adults with urinary stone disease who underwent metabolic evaluation and the providers who ordered the evaluation. By focusing on patients with an abnormality on the initial collection we determined the proportion who underwent a followup test within 6 months of the initial test. Multilevel modeling was done to quantify variation in followup testing among providers after accounting for various patient and provider factors. RESULTS A total of 208,125 patients had an abnormality on the initial collection, of whom only 33,413 (16.1%) performed a repeat collection within 6 months. While most variation in followup testing was attributable to the patient, the provider contribution was nontrivial (18.0%). The specialty of the ordering provider was important. Patients who saw a urologist had 24% lower odds of repeat testing compared to those who saw a primary care physician (OR 0.76, 95% CI 0.67-0.86, p <0.001). CONCLUSIONS Followup testing is uncommon in patients with an abnormal initial 24-hour urine collection. Given the observed provider variation, efforts to educate providers on the value of followup testing are likely to have salutary effects on patients with metabolic stone disease.
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Affiliation(s)
- Casey A Dauw
- Divisions of Endourology and Stone Disease and Health Services Research, Department of Urology, University of Michigan Medical School, Ann Arbor, Michigan; Litholink, Laboratory Corporation of America Holdings (JRA), Chicago, Illinois
| | - Abdulrahman F Alruwaily
- Divisions of Endourology and Stone Disease and Health Services Research, Department of Urology, University of Michigan Medical School, Ann Arbor, Michigan; Litholink, Laboratory Corporation of America Holdings (JRA), Chicago, Illinois
| | - Maggie J Bierlein
- Divisions of Endourology and Stone Disease and Health Services Research, Department of Urology, University of Michigan Medical School, Ann Arbor, Michigan; Litholink, Laboratory Corporation of America Holdings (JRA), Chicago, Illinois
| | - John R Asplin
- Divisions of Endourology and Stone Disease and Health Services Research, Department of Urology, University of Michigan Medical School, Ann Arbor, Michigan; Litholink, Laboratory Corporation of America Holdings (JRA), Chicago, Illinois
| | - Khurshid R Ghani
- Divisions of Endourology and Stone Disease and Health Services Research, Department of Urology, University of Michigan Medical School, Ann Arbor, Michigan; Litholink, Laboratory Corporation of America Holdings (JRA), Chicago, Illinois
| | - J Stuart Wolf
- Divisions of Endourology and Stone Disease and Health Services Research, Department of Urology, University of Michigan Medical School, Ann Arbor, Michigan; Litholink, Laboratory Corporation of America Holdings (JRA), Chicago, Illinois
| | - John M Hollingsworth
- Divisions of Endourology and Stone Disease and Health Services Research, Department of Urology, University of Michigan Medical School, Ann Arbor, Michigan; Litholink, Laboratory Corporation of America Holdings (JRA), Chicago, Illinois.
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15
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Lee TTN, Elkoushy MA, Andonian S. Are stone analysis results different with repeated sampling? Can Urol Assoc J 2014; 8:E317-22. [PMID: 24940457 DOI: 10.5489/cuaj.1872] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We assessed differences in results of stone analyses on subsequent sampling. METHODS A retrospective review of patients with stone analyses at a tertiary stone centre between March 2006 and July 2012 was performed. All stones were analyzed at a centralized laboratory using infrared spectroscopy. Patients were grouped according to the first predominant stone type on record, as defined by the predominant stone component of at least 60%. Stone groups included calcium oxalate (CaOx), calcium phosphate (CaP), uric acid (UA), cystine, struvite, mixed CaOx-CaP and mixed CaOx-UA. All patients had a full metabolic stone workup. RESULTS Of the 303 patients with stone analyses, 118 (38.9%) patients had multiple stone analyses. The mean age was 53.4 ± 15.1 years, and 87 (73.7%) were males. Of the 118, the initial stone analysis showed 43 CaOx, 38 CaP, 21 UA, 4 CaOx-CaP, 2 CaOx-UA, 6 cystine, and 4 struvite. There was a different stone composition in 25 (21.2%) patients with a median time delay of 64.5 days. Different compositions were found in 7 CaOx (to 3 CaP, 2 CaOx-CaP, and 2 UA), 5 CaP (to 3 CaOx and 2 CaOx-CaP), 3 UA (to 3 CaOx), 4 CaOx-CaP (to 2CaOx, 1 UA and 1 CaP), 2 CaOx-UA (to 2 CaOx) and 4 struvite (to 3 CaP and 1 UA). CONCLUSIONS Stone composition was different in 21.2% of patients on subsequent analyses.
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Affiliation(s)
- Terence T N Lee
- Division of Urology, Department of Surgery, McGill University Health Centre, Montreal, QC
| | - Mohamed A Elkoushy
- Division of Urology, Department of Surgery, McGill University Health Centre, Montreal, QC
| | - Sero Andonian
- Division of Urology, Department of Surgery, McGill University Health Centre, Montreal, QC
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Lee MC, Bariol SV. Changes in upper urinary tract stone composition in Australia over the past 30 years. BJU Int 2013; 112 Suppl 2:65-8. [DOI: 10.1111/bju.12383] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Ming-Chak Lee
- Department of Urology; Westmead Hospital; New South Wales Australia
| | - Simon Virgil Bariol
- Department of Urology; Westmead Hospital; New South Wales Australia
- University of Sydney; New South Wales Australia
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Nayan M, Elkoushy MA, Andonian S. Variations between two 24-hour urine collections in patients presenting to a tertiary stone clinic. Can Urol Assoc J 2012; 6:30-3. [PMID: 22396364 DOI: 10.5489/cuaj.11131] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The current Canadian Urological Association (CUA) guideline recommends two 24-hour urine collections in the metabolic evaluation for patients with urolithiasis. The aim of the present study was to compare two consecutive 24-hour urine collections in patients with a history of urolithiasis presenting to a tertiary stone clinic. METHODS We retrospectively reviewed 188 patients who had two 24-hour collections upon presentation between January 2010 and December 2010. Samples were collected on consecutive days and examined for the following 11 urinary parameters: volume, creatinine, sodium, calcium, uric acid, citrate, oxalate, potassium, phosphorous, magnesium and urea nitrogen. For each parameter, the absolute value of the difference between the two samples rather than the direct difference was compared with zero. Similarly, the percent difference between samples was calculated for each parameter. RESULTS The means of the absolute differences between the two samples were significantly different for all 11 urinary parameters (p < 0.0001). The percent differences for all urinary parameters ranged from 20.5% to 34.2%. Furthermore, 17.1% to 47.6% of patients had a change from a value within normal limits to an abnormal value, or vice-versa. Significance was maintained when patients with incomplete or over-collections were excluded. CONCLUSIONS Significant variations among the two 24-hour urine collections were observed in all of the 11 urinary parameters analyzed. This variation may change clinical decision-making in up to 47.6% of patients if only a single 24-hour urine collection is obtained. The present study supports the CUA guideline of performing two 24-hour urine collections.
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Affiliation(s)
- Madhur Nayan
- Division of Urology, Department of Surgery, McGill University Health Centre, McGill University, Montreal, QC
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Norman RW. Optimizing the void. Can Urol Assoc J 2012; 6:34-5. [PMID: 22396365 DOI: 10.5489/cuaj.12010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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