STUDY ON UROLITHIASIS

ESPECIALLY ON CLINICAL OBSERVATION AND INFRARED SPECTROSCOPIC ANALYSIS OF URINARY STONES

Abstract

To begin with, the statistical obserbation of the urolithiasis in 978 cases of the outpatients from 1949 to 1958 was performed, and the following reuslts were obtained.
1. Frequency: The frequency of urolithiasis shows 6.17% to the total numbers of the outpatients. In 978 cases of urolithiasis, there have 227 cases (23.2%) of renal stone, 520 cases (53.2%) of ureteral stone, 184 cases (18.8%) of bladder stone, 41 cases (4.19%)of urethral stone and 6 cases (0.61%) of prostate stone. Periodical observation of the urolithiasis shows the phenomenon so-called stone wave remarkably.
2. Age: More than an half of the urolithiasis were found in young people from 21 to 40 years old. In the upper urinary stone, about two third of them were the young people aged 21 to 40, but in the lower urinary stone, about two fifth of them were the older people aged 51 to 80.
3. Sex: Incidence of the urolithiasis in male was about five times to that of female.
4. Occupation: Most cases were found in the salaried class, then laborer and farmer followed.
5. Season of Incidence: The urolithiasis were found more in Summer than in Winter.
6. Urolithiasis in children shows 7.4% to the total numbers of the urolithiasis. In my observation, the upper urinary stones in children were apparently more than the lower urinary stones, it may be considered as a phenomenon so-called stone wave in children.
7. In the total patients of the urolithiasis, 17.47% of them have a past history of urolithiasis. and 12.2% of recurrence rate was obtained from the 164 inpatients operated.
8. X-ray negative stones revealed 4.85%.
9. Spontaneous excretion of the urinary stones had 16.71%.
10. Characteristic symptoms of the upper urolithiasis were the colic attack and hematuria, but in the lower urolithiasis, disturbance of the urination and hematuria appeared as the main symptoms.
11. Existence of ureteral stones: Majority of the ureteral stones exist in the lower ureter.
12. Prognosis of urolithiasis: Twenty cases out of 164 cases of the inpatients operated had a recurrence of the urolithiasis. Generally, prognosis of the urolithiasis is good, but the prevention of its recurrence is still remained in question.
Secondly, analyses of the 165 urinary stones were performed in order to kuow the exact chemical composition of them by the infrared spectroscopy. A double beam self-recording infrared spectrophotometer (Hilger H-800) was used in this study. The samples were prepared by Nujol method and KBr tablet method and found that the latter is good for analysis of urinary stones. The results of the analyzed stones revealed 69.7% of compound stone and 30.3% of single stone. In 165 cases of the urinary stones, most of them were calcium oxalate tribasic calcium phosphate stones (56.7%). Including components of the urinary stones revealed most frequent in calcium oxalate (45.8%), tribasic calcium phosphate (37.0%) and magnesium ammonium phosphate (10.2%) followed it. Different components between central nucleus and outmost layer of the urinary stones were noticed in 21%. Up to present, rarely reported ammonium urate stone, Sodium urate stone and dibasic calcium phosphate stone were found by infrared spectroscopy. Quantitative analyses of the compound stones, especially of the tribasic calcium phosphate calcium oxalate stones were performed, and their mixed ratio were determined by infrared spectra. As above mentioned, analyses of the urinary stones by infrared spectra are a new useful method which can be used not only to the qualitative identification but also applicated to the quantitative identification. Infrared spectra were obtained from small samples (less than 3mg) with a simple procedure and accurate results were determined by these spectra.
Thirdly, analyses of the twelve cases of the crystalluria were performed by infrared spectroscopy. Carbonaturia examined by Ultzmann' uroscopy Showed calcium phosphate in addition to calcium carbonate on