THE RECURRENCE OF UROLITHIASIS

BASED ON 735 URINARY STONE ANALYSIS OF 700 PATIENTS

Abstract

Seven hundred patients with urolithiases, treated from 1953 through 1970, were studied for the stone recurrence. The length of the follow-up period was from 1 year and 0 month to 19 years and 0 month, the mean being 8 years and 8 months. The chemical compositions of 735 urinary calculi from these patients were analysed by infrared spectroscopy. The sites of 735 calculi are shown in Table 1. The age distribution and the sex of 700 patients are shown in Fig. 1-2. Of these 700 patients, 422 cases were possible to follow up; 250 cases have had no further stone, 138 cases experienced recurrent stones and 34 cases had multiple stones (i. e., stones of bilateral upper urinary tracts, or both of upper and lower urinary tracts).
The results of survey study on these 422 cases were following;
1) Of 383 patients with upper urinary tract calculi, 163 cases (42.6per cent) have had their recurrent stones (the cases with multiple calculi included). The percentage recurrence was 43.6per cent for males and 40.0per cent for females. Although the highest incidence of stone recurrence was noticed in 30-39 year and 70-79 year in age, there was no marked difference of stone recurrence at different ages (Fig. 1, Table 2). Of 39 patients with lower urinary tract calculi, 9 cases (23.1per cent) have had their recurrent stones. The percentage recurrence was 22.9per cent for males and 25.0per cent for females (Fig. 2, Table 3).
2) Relationships between the sites of initial stone and the stone recurrence: Percentage recurrence was 34.4per cent for rt. upper urinary tract calculi, 39.1per cent for lt. upper urinary tract calculi and 23.1per cent for lower urinary tract calculi (Table 4).
3) Recurrence rates according to stone compositions: 41.2per cent of the patients with oxalate-phosphate calculi, 38.7per cent of the patients with magnesium ammonium phosphate calculi, 55.6per cent of the patients with uric acid calculi, 22.2per cent of the patients with urate calculi and 50.0per cent of the patients with cystine calculi have had their recurrent stones (Table 5-6).
4) Recurrence rates according to the types of removal of initial stones were: 12.5per cent of partial nephrectomy, 16.6per cent of basket catheter, 22.6per cent of nephrectomy, 30.0per cent of nephrolithotomy, 30.0per cent of pyelolithotomy, 38.4per cent of ureterolithotomy, 59.3per cent following spontaneous discharges of stones, 13.3per cent of cystolithotomy, 28.6per cent of cystolitholapaxy and 31.3per cent of cystolithotripsy (Table 8-9).
5) The average interval between initial stone and first recurrence was 4 years and 0 month. Most of recurrences occurred in 1-2 years following the removal of initial stones (Table 10).
6) The times of recurrences: 70.3per cent of patients with recurrent stones have had only one recurrence and 5.8per cent of patients have had frequent recurrences of over 7 times (Table 11).
7) The urinary excretion values of calcium, magnesium, phosphorus and uric acid in patients with oxalate-phosphate calculi were not different between the patients without recurrence and those with recurrences. However, the ratio of magnesium/calcium×oxalic acid in urine of the patients with recurrent oxalate-phosphate calculi was significantly lower than that in urine of the patients without stone recurrence (Fig. 3, Table 13).