Analysis of Urinary Stone Composition: A Retrospective Single Center Study during the Last Five Years (2009-2013)

Pil Moon Kang; Won Ik Seo; Dong Il Kang

doi:10.14777/kjutii.2014.9.1.44

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Kang, Seo, and Kang: Analysis of Urinary Stone Composition: A Retrospective Single Center Study during the Last Five Years (2009-2013)

Original Article

Korean J Urogenit Tract Infect Inflamm 2014;9(1):44-49.

Published online: 17 April 2014

DOI: https://doi.org/10.14777/kjutii.2014.9.1.44

Analysis of Urinary Stone Composition: A Retrospective Single Center Study during the Last Five Years (2009-2013)

Pil Moon Kang, Won Ik Seo, Dong Il Kang

Department of Urology, Inje University College of Medicine, Busan, Korea

Correspondence to: Dong Il Kang Department of Urology, Inje University Busan Paik Hospital, 75, Bokji-ro, Busanjin-gu, Busan 614-735, Korea Tel: +82-51-890-6439, Fax: +82-51-892-9887 E-mail: urokang@lycos.co.kr

Received 14 February 201424 March 2014 Accepted 27 March 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

Analysis of urinary stone composition is essential for treatment and prevention of urolithiasis. We evaluated the effect of age, gender, and stone location on urinary stone components during the last five years.

Materials and Methods

We conducted a retrospective analysis of the medical records of 375 patients ranging in age from 15 years old to 93 years old (241 males and 134 females) who underwent conventional or endoscopic surgery, shock wave lithotripsy, or passed their stones spontaneously between 2009 and 2013. Stone analysis was performed using a chemical analysis method to determine the molecular composition of each stone.

Results

Of the 375 patients with urolithiasis, 152 patients (40.5%) had predominantly calcium oxalate, 85 patients (21.5%) had uric acid, 17 patients (4.5%) had calcium phosphate, 17 patients (4.5%) had magnesium ammonium phosphate, 16 patients (4.3%) had calcium carbonate, and 86 patients (22.9%) had mixed stone type. There was a decreasing prevalence of calcium oxalate stone with age group (42.5% in young adult (20-39 years, n=40), 45.0% in adult (40-60 years, n=151), and 32.7% in elderly (≥60 years, n=180) as opposed to increasing prevalence in uric acid stone (7.5% in young adult, 15.2% in adult and 32.2% in elderly). Uric acid stones were more common in males and in lower urinary tract stones.

Conclusions

In this study, the incidence of calcium oxalate decreased with age and that of uric acid increased with age and in male. In comparison of the results of previous studies for several decades, the incidence of uric acid increased in the last five years.

Keywords: Urinary calculi, Analysis, Uric acid

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Table 1.

Components of 375 urinary calculi and distribution according to the gender

Stone component	Patients	Gender
Stone component	Patients	Male	Female
Pure (n=289)
CaOx	152 (40.5)	94 (39.0)	58 (43.2)
UA	85 (21.5)	69 (28.6)	16 (11.9)
CaP	17 (4.5)	13 (5.3)	4 (2.9)
MAP	17 (4.5)	9 (3.7)	8 (5.9)
AAU	0	0	0
Cystine	2 (0.5)	2 (0.8)	0
CaCarb	16 (4.3)	4 (1.7)	12 (8.9)
Mixed (n=86)
CaOx+UA	23 (6.1)	19 (7.9)	4 (2.9)
CaOx+CaP	6 (1.6)	3 (1.2)	3 (2.2)
CaOx+MAP	1 (0.3)	0	1 (0.7)
CaOx+CaCarb	14 (3.7)	8 (3.3)	6 (4.5)
UA+CaP	2 (0.5)	2 (0.8)	0
UA+MAP	4 (1.1)	4 (1.7)	0
UA+Cystine	1 (0.3)	0	1 (0.7)
UA+CaCarb	1 (0.3)	0	1 (0.7)
CaP+Cystine	1 (0.3)	0	1 (0.7)
CaP+CaCarb	13 (3.5)	4 (11.7)	9 (6.7)
MAP+CaCarb	7 (1.9)	3 (1.2)	4 (3.0)
CaOx+UA+CaCarb	2 (0.5)	2 (0.8)	0
CaOx+CaP+CaCarb	11 (2.9)	5 (2.0)	6 (4.5)
Total	375	241	134

Values are presented as number (%). CaOx: calcium oxalate, UA: uric acid, CaP: calcium phosphate, MAP: magnesium ammonium phosphate, AAU: ammonium acid, CaCarb: calcium carbonate.

Table 2.

Distribution of urinary stone according to the age

Stone component	Age
Stone component	Child	Young	Adult	Elderly
Pure
CaOx	3 (75.0)	17 (42.5)	68 (45.0)	59 (32.7)
UA		3 (7.5)	23 (15.2)	58 (32.2)
CaP	1 (25.0)	6 (15)	6 (3.9)	3 (1.6)
MAP	-	2 (5)	4 (2.6)	11 (6.1)
AAU	-	-	-	-
Cystine	-	2 (5)	-	-
CaCarb	-	2 (5)	8 (5.2)	9 (5.0)
Mixed
CaOx+UA	-	1 (2.5)	9 (5.9)	13 (7.2)
CaOx+CaP	-	-	8 (5.2)	3 (1.7)
CaOx+MAP	-	-	4 (2.6)	-
CaOx+CaCarb	-	1 (2.5)	7 (4.6)	6 (3.3)
UA+CaP	-	1 (2.5)	-	1 (0.6)
UA+MAP	-	-	2 (1.3)	3 (1.7)
UA+Cystine	-	1 (2.5)	-	-
UA+CaCarb	-	1 (2.5)	-	1
CaP+Cystine	-	1 (2.5)	-	-
CaP+CaCarb	-	1 (2.5)	5 (3.3)	8
MAP+CaCarb	-	-	-	2
CaOx+UA+CaCarb	-	-	-	-
CaOx+CaP+CaCarb	-	-	-	-
Total	4	40	151	180

Values are presented as number (%). Child (0-19 years), young (20-39 years), adult (40-59 years), elderly (over 60 years). CaOx: calcium oxalate, UA: uric acid, CaP: calcium phosphate, MAP:magnesium ammonium phosphate, AAU: ammonium acid, CaCarb:calcium carbonate.

Table 3.

Distribution of urinary stone according to the location

Stone component	Location
Stone component	Kidney	Ureter	Bladder	Urethra
Pure
CaOx	41 (35.6)	93 (50.5)	17 (24.2)	2 (33.3)
UA	21 (18.2)	41 (22.2)	22 (31.4)	1 (16.7)
CaP	5 (4.3)	7 (3.8)	2 (2.8)	1 (16.7)
MAP	8 (6.9)	2 (1.0)	7 (10.0)	-
AAU	-	-	-	-
Cystine	2 (1.7)	-	-	-
CaCarb	8 (6.9)	7 (3.8)	1 (1.4)	-
Mixed
CaOx+UA	10 (8.7)	6 (3.3)	6 (8.6)	-
CaOx+CaP	-	5 (2.7)	1 (1.4)	-
CaOx+MAP	-	-	1 (1.4)	-
CaOx+CaCarb	6 (5.2)	5 (2.7)	4 (5.7)	1 (16.7)
UA+CaP	1 (0.9)	1 (0.5)	-	-
UA+MAP	1 (0.9)	-	3 (4.3)	-
UA+Cystine	-	1 (0.5)	-	-
UA+CaCarb	-	2 (1.1)	-	-
UA+CaCarb CaP+Cystine	- 1 (0.9)	2 (1.1) -	- -	- -
CaP+CaCarb	3 (2.6)	5 (2.7)	3 (4.3)	1 (16.7)
MAP+CaCarb	5 (4.3)	-	2 (2.9)	-
CaOx+UA+CaCarb	1 (0.9)	1 (0.5)	-	-
CaOx+CaP+CaCarb	2 (1.7)	8 (4.3)	1 (1.4)	-
Total	115	184	70	6

Values are presented as number (%). CaOx: calcium oxalate, UA: uric acid, CaP: calcium phosphate, MAP: magnesium ammonium phosphate, AAU: ammonium acid, CaCarb: calcium carbonate.

Table 4.

Compairing data - current and previous periods

	Kang et al. (present case)	Byeon et al.¹²	Ye et al.¹³
	Kang et al. (present case)	Byeon et al.¹²	A	B
Duration (y)	2009-2013	1985-1995	1986-1995	1996-2005
Case (n)	375	495	301	158
Age (y)	2-93 (57.6±14.4)	2-76 (49.5±12.5)	47.2±14.5	46.0±10.2
Sex ratio (male:female)	1.8:1	1.8:1	2.04:1	1.98:1
Location	-	-	-	-
Kidney	115	307	110	61
Ureter	184	103	166	81
Bladder	70	75	15	10
Urethra	6	10	10	6
Stone analysis method	Chemical analysis	Chemical analysis	Louis C. Herring and Company
Stone component
Pure	-	-	-	-
CaOx	152 (40.5)	173 (46.3)	30 (10.0)	12 (7.6)
UA	85 (21.5)	18 (3.6)	17 (5.6)	24 (15.2)
CaP	17 (4.5)	23 (4.6)	5 (1.7)	7 (4.4)
MAP AAU	17 (4.5) -	15 (3.0) -	- -	- -
Cystine	2 (0.5)	-	1 (0.3)	1 (0.6)
CaCarb	16 (4.3)	-	-	-
Mixed
CaOx+UA	23 (6.1)	16 (3.2)	18 (6.0)	10 (6.3)
CaOx+CaP CaOx+MAP	6 (1.6) 1 (0.3)	118 (23.8) 17 (3.4)	182 (60.5) 3 (1.0)	80 (50.6) 1 (0.6)
CaOx+CaCarb	14 (3.7)	-	-	-
CaOx+AAU	-	-	2 (0.7)	-
UA+CaP	2 (0.5)	6 (1.2)	-	-
UA+MAP	4 (1.1)	3 (0.6)	-	-
UA+Cystine UA+CaCarb	1 (0.3) 1 (0.3)	- -	- -	- -
UA+AAU	-	-	-	2 (1.3)
CaP+Cystine	1 (0.3)	-	-	-
CaP+CaCarb	13 (3.5)	-	-	-
CaP+MAP	-	-	5 (1.7)	9 (5.7)
MAP+CaCarb CaOx+Cystine	7 (1.9) -	- 1 (0.2)	- -	- -
CaP+MAP	-	20 (4.0)	-	-
CaOx+UA+CaCarb	2 (0.5)	-	-	-
CaOx+CaP+CaCarb	11 (2.9)	-	-	-
CaOx+CaP+MAP	-	71 (14.3)	14 (4.7)	4 (2.5)
CaOx+MAP+UA CaOx+CaP+UA	- -	1 (0.2) 7 (1.4)	- 9 (3.0)	- -
CaOx+CaP+Cys	-	1 (0.2)	-	-
CaOx+UA+ AAU	-	-	1 (0.3)	1 (0.6)
CaOx+CaP+AAU	-	-	2 (0.7)	-
CaP+MAP+UA	-	5 (1.0)	-	-
CaP+MAP+AAU CaOx+CaP+MAP+AAU	- -	- -	7 (2.3) 1 (0.3)	4 (2.5) 1 (0.6)
CaOx+CaP+UA+AAU	-	-	3 (1.0)	2 (1.3)
CaOx+CaP+UA+MAP+AAU	-	-	1 (0.3)	-

Values are presented as number (%), range (mean±standard deviation) or mean±standard deviation only.CaOx: calcium oxalate, UA: uric acid, CaP: calcium phosphate, MAP: magnesium ammonium phosphate, AAU: ammonium acid, CaCarb: calcium carbonate.

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