Does bladder stone composition predict kidney stone composition?

INTRODUCTION Bladder stones have historically been associated with urinary stasis secondary to bladder outlet obstruction (BOO). Recent studies indicate that the role of BOO in bladder stone formation is minor. We evaluate the role of urinary lithogenic factors in bladder stone formation by comparing the compositions of bladder stones and kidney stones in patients with multi-site urinary calculi. MATERIALS AND METHODS: We identified patients who were treated for concomitant bladder stones and kidney stones between 2008-2019, and had both stone compositions available. Patients with bladder stone size < 10 mm, urinary foreign bodies, encrusted stents or tumors were excluded. Data regarding urinary symptoms, residual volumes, stone composition and 24-hours urine data were collected. RESULTS: We identified 40 males with a median age of 72 years (IQR 6-14), median residual volume of 76 mL (IQR 41-200), and a median prostate volume of 52 mL (IQR 32-102). Bladder outlet procedures were performed concomitantly with cystolitholapaxy in 21 (53%) patients. The most common bladder stone and kidney stone compositions were CaOx (47.5% and 65%), uric acid (32.5% and 22.5%), calcium phosphate (15% and 10%), and struvite (5% and 2.5%), respectively. Bladder stone and kidney stone compositions were identical in 70% of patients. Bladder stone composition was predictive of kidney stone composition, regardless of the PVR, bladder stone size, or whether an outlet procedure was performed. CONCLUSION: We found a high concordance between bladder stone and kidney stone composition, suggesting that metabolic abnormalities have a significant role in bladder stone formation. Bladder stone composition can be used to guide surgical and medical treatment for kidney stones in metabolically active stone patients.

[Clinical implications of dual-energy computed tomography in the diagnosis and treatment of urolithiasis].

Urolithiasis (urolithiasis) is one of the most common urologic diseases with an estimated prevalence of no less than 3% in the population, usually affecting active working-age patients of 30-50 years. Taking into account major public health and economic significance of this problem, there is the need for the development of effective modern diagnostic techniques. Rapid medical-technological advances of the past two decades have led to the wide spread use of minimally invasive surgery the management of urolithiasis. Nevertheless, surgical intervention only removes the result of a long pathological process and does not change its course. Thus, there is a need for a detailed understanding of the etiology, epidemiology, and pathogenesis of urolithiasis. Diagnostic imaging plays a key role in the diagnosis of urolithiasis. Multislice spiral computed tomography (MSCT) is the gold standard for the diagnosis of urolithiasis. It provides information about the size, location, and density of the calculus. Over the past decade, the use of dual-energy computed tomography (DECT) in urological practice has been widely discussed in the international and domestic literature. One of the main advantages of DECT is the ability to determine the chemical composition of urinary stones. Previous studies have reported a high diagnostic value of the method, including the ability to predict treatment outcomes. However, the shortcomings of the method and the absence of standardized examination protocols leave a wide field for further research. This article reviews major distinctive features of using DECT in the diagnosis of urolithiasis.

Evaluation of 21 426 feline bladder urolith submissions to the Canadian Veterinary Urolith Centre (1998-2014).

This study reports emerging trends in feline urolithiasis in Canada during the past 16.8 y, evaluates associations of breed and gender with urolith types, and reports on feline submissions from outside of Canada. Struvite and calcium oxalate uroliths comprised > 90% of all uroliths submitted. In cats, oxalate submissions outnumbered struvite submissions from Canada, Hong Kong, Denmark, and the United Arab Emirates, while Australian struvite submissions outnumbered calcium oxalate submissions. In Canada, the majority of urolith submissions were from domestic cats followed by Himalayan, Persian, and Siamese cats. Males were more likely to form calcium oxalate uroliths and females were more likely to develop struvite uroliths. Compared to domestic short-haired cats, Tonkinese, Burmese, Devon rex, Himalayan, Persian, and Siamese cats were significantly associated with calcium oxalate urolith submission. Egyptian mau, Birman, ocicat, and Siamese breeds were over-represented amongst urate submissions.

Évaluation de 21 426 soumissions d'urolithes de vessie au Centre canadien d'urolithes vétérinaires (1998­2014). Cette étude présente un rapport sur les tendances émergentes pour l'urolithiase féline au Canada pendant les 16,8 dernières années, évalue les associations avec la race et le sexe pour les types d'urolithes et établit un rapport sur les soumissions félines provenant de l'extérieur du Canada. Les urolithes de struvite et d'oxalate de calcium représentaient > 90 % de tous les urolithes soumis. Chez les chats, les soumissions d'oxalate étaient supérieures aux soumissions de struvite pour les échantillons provenant du Canada, de Hong Kong, du Danemark et des Émirats arabes unis, tandis que les soumissions de struvite provenant de l'Australie étaient supérieures aux soumissions d'oxalate de calcium. Au Canada, la majorité des soumissions d'urolithes provenaient de chats domestiques suivis des chats himalayens, persans et siamois. Il était plus probable que les mâles aient des urolithes d'oxalate de calcium et il était plus probable que les femelles développent des urolithes de struvite. Comparativement aux chats domestiques à poil court, les chats tonkinois, burmese, Devon rex, himalayens, persans et siamois présentaient une association importante avec une soumission d'urolithes d'oxalate de calcium. Les races de chat Mau égyptien, birman, ocicat et siamois étaient surreprésentées parmi les soumissions d'urate.(Traduit par Isabelle Vallières).

[The influence of alternating magnetic field on in vitro litholysis of uroliths in blemaren water solutions].

THE AIM OF THE RESEARCH: increase of efficiency of urolith in vitro solution using water Blemaren medication solutions after their exposure to 2 Hz alternating magnetic field. MATERIALS AND METHODS: water solution of Blemaren medication with pH=6,15 in concentrations corresponding to single portion of medication (1 tablet m=3,5282 g per 250 ml of water) and uroliths (oxalates, urates including uncommon xanthine calculi). Composition of calculi was determined by means of X-ray tests and IR spectroscopy. Photometry of Blemaren with saluted portion of calculi was conducted. RESULTS: it was established that in the Blemaren solutions which had been previously exposed to 2 Hz alternating magnetic filed during one hour the solution process is 1.92 - 2 times more effective than in common water solutions. Discussion - in control solutions pH values increased 5.65 - 6.8 times in the course of time, whereas in the Blemaren solutions exposed to alternating magnetic field pH values remained virtually unaltered during the whole experiment. CONCLUSION: there were detected significant differences in pH values of Blemaren solutions and its solvent properties between solutions which were exposed to alternating magnetic filed and those which were not.

Uric acid stones in the urinary bladder of aryl hydrocarbon receptor (AhR) knockout mice.

The aryl hydrocarbon receptor (AhR) knockout mice raised in the laboratory of Fujii-Kuriyama have been under investigation for several years because of the presence in their urinary bladder of large, yellowish stones. The stones are composed of uric acid and become apparent in the bladders as tiny stones when mice are 10 wk of age. By the time the mice are 6 mo of age, there are usually two or three stones with diameters of 3-4 mm. The urate concentration in the serum was normal but in the urine the concentration was 40-50 mg/dL, which is 10 times higher than that in the WT littermates. There were no apparent histological pathologies in the kidney or joints and the levels of enzymes involved in elimination of purines were normal. The source of the uric acid was therefore judged to be from degradation of nucleic acids due to a high turnover of cells in the bladder itself. The bladder was fibrotic and the luminal side of the bladder epithelium was filled with eosinophilic granules. There was loss of E-cadherin between some epithelial cells, with an enlarged submucosal area filled with immune cells and sometimes invading epithelial cells. We hypothesize that in the absence of AhR there is loss of detoxifying enzymes, which leads to accumulation of unconjugated cytotoxins and carcinogens in the bladder. The presence of bladder toxins may have led to the increased apoptosis and inflammation as well as invasion of epithelial cells in the bladders of older mice.

Metals in Human Gall, Bladder, and Kidney Stones Based on an Electron Microprobe Investigation.

Several particles of copper accompanied by a few particles of nickel, lead, and a compound composed of selenium containing minor Ni, Si, Cu, and Co were found in human gall, kidney, and bladder stones. The investigated particles occur as tiny grains, <10 µm in size, that are irregularly dispersed in the stones. Therefore, they were studied by scanning electron microscopy and qualitatively analyzed by energy dispersive system. One grain of copper contained a small amount of Ni and Zn, and some grains of nickel proved to contain Cr as trace element. Most of the discovered metals formed a single-phase grain. However, a few grains found in two gallstones were associated with inclusions of calcium and apatite. Based on the results presented in this contribution, we argue that most of the studied metals can be classified as endogenous particles, i.e., directly precipitated from the same fluids that formed their host human stones. This observation suggests that the precipitation and accumulation of metals in some human stones can be considered an efficient way to eliminate them from the human body.

[Cystine urolithiasis: recommendations for diagnosis, treatment and recurrence prevention]. / Cistinska urolitijaza: preporuke za dijagnostiku, lijecenje i prevenciju recidiva.

Cystine lithiasis is a diagnostic and therapeutic challenge. This consensus document has outgrown of discussion of experts in nephrology and urology. It is our hope that this document will be of use for all physicians who are facing this disturbing type of urolithiasis. So far, in our national literature there have been no comprehensive documents dealing with this entity and we believe that not only nephrologists and urologists will benefit, but also specialists in internal medicine and general practitioners.

Raman spectroscopic documentation of Oligocene bladder stone.

Discovery of a fossil (30-35 million-year-old) urolith from Early Oligocene deposits in northeastern Colorado provides the earliest evidence for the antiquity of bladder stones. These are spherical objects with a layered phosphatic structure and a hollow center. Each layer is composed of parallel crystals oriented perpendicular to the surface. Macroscopic and microscopic examination and X-ray diffraction analysis, along with comparison with 1,000 contemporary uroliths, were used as evidence in the confirmation of this diagnosis. Raman microspectroscopy verified the presence of organic material between layers, confirming its biologic origin.

Significance of twinkling artifact on ultrasound in the diagnosis of cystine urolithiasis.

Twinkling artifact (TA) refers to the finding characterized by both a high-echoic mass upon B-mode ultrasound (US) and turbulence-like signals over the entire mass without significant blood flow on color Doppler US. TA is a characteristic sign of urolithiasis, and there has been no previous report on this finding in the digestive tract. The authors recently encountered a 2-year 9-month-old boy with cystinuria presenting with an opacified abdominal mass. Although he was originally diagnosed as having calcified stool mass, the finding of TA upon US led to the correct diagnosis of huge urolith (4.2 cm in diameter) in the urinary bladder. Laparotomic stone removal was successfully conducted and the calculus was confirmed to be composed of cystine. The finding of TA upon US facilitates identification of the structure and location of the intra-abdominal mass.

Laparoscopic-assisted cystotomy for urolith removal in dogs and cats - 23 cases.

This report describes the outcomes of a modified laparoscopic-assisted cystotomy for urolith removal in dogs and cats. Modifications of the original techniques included a temporary cystopexy to the abdominal wall, utilization of a laparoscope instead of cystoscope, and retrograde flow of saline in the bladder with pressurized saline. The medical records of 23 client-owned animals for which laparoscopic-assisted cystotomy was used for urolith extraction were reviewed. Twenty-six procedures were performed in 23 animals. There were intraoperative complications in 19.2% of cases leading to open conversion in 11.5%. Rate of complications directly related to the procedure was 11.5%. Four cases had documented urolith recurrence with a mean time to recurrence of 335 days.

Cystotomie assistée par laparoscopie pour l'enlèvement des urolithes chez les chiens et les chats ­ 23 cas. Ce rapport décrit les résultats d'une cystotomie assistée par laparoscopie pour l'enlèvement des urolithes chez les chiens et les chats. Les modifications des techniques originales ont inclus une cystopexie temporaire à la paroi abdominale et un flux rétrograde de la solution saline dans la vessie avec une solution saline sous pression. Les dossiers médicaux de 23 animaux appartenant à des propriétaires pour lesquels la cystotomie par laparoscopie avait été utilisée pour l'extraction des urolithes ont été examinés. Vingt-six interventions ont été réalisées chez 23 animaux. Il y a eu des complications peropératoires dans 19,2 % des cas causant une conversion ouverte à 11,5 %. Le taux des complications directement reliées à l'intervention était de 11,5 %. Pour quatre cas, il y a eu une récurrence documentée des urolithes avec une durée moyenne de 335 jours.(Traduit par Isabelle Vallières).

Cystine urolithiasis in a caracal (Caracal caracal).

In July 2009, a 14-yr-old male caracal (Caracal caracal) at the National Zoological Gardens of South Africa was found, on abdominal ultrasound, to have a single large cystolith. The cystolith was removed, and the composition was determined to be 100% cystine. Blood and urine samples were also collected from three other apparently healthy caracals at the zoo and were submitted, together with the samples from the affected animal, for analysis using gas chromatograph mass spectrometry for cystine, lysine, alanine, and ornithine levels. The cystine levels in the urine, the fractional excretion of cystine, and the normalized excretion of cystine (micromol/g of creatinine) were all higher in the affected caracal than in the healthy animals. Only a single other case of cystine urolithiasis has been previously reported in any wild felid in the literature.

A diet with a struvite relative supersaturation less than 1 is effective in dissolving struvite stones in vivo.

Magnesium ammonium phosphate (struvite) is one of the most common minerals found in feline uroliths. Previous studies have shown the efficacy of acidifying calculolytic diets (inducing urine pH < 6.5), in dissolving struvite stones in cats. Recent work in our laboratory found that wet and dry test diets induce a struvite urinary relative supersaturation (RSS) < 1 and that the urine of healthy cats fed the dry test diet dissolved feline struvite stones in vitro. The objective of the present study was to demonstrate the efficacy of those test diets on naturally occurring struvite urocystoliths in cats. A total of twenty-one cats were used, of which seventeen completed the study. Of the seventeen cats, eight were fed the wet test diet and nine the dry test diet. Uroliths dissolved in a median of 18 (10-55) d. In the remaining four cats, uroliths failed to dissolve and were removed surgically. Quantitative analysis showed that these uroliths contained either calcium oxalate or calcium phosphate. The present study demonstrates that diets that induce a struvite RSS < 1 result in struvite stone dissolution in vivo.

History, epidemiology and regional diversities of urolithiasis.

Archeological findings give profound evidence that humans have suffered from kidney and bladder stones for centuries. Bladder stones were more prevalent during older ages, but kidney stones became more prevalent during the past 100 years, at least in the more developed countries. Also, treatment options and conservative measures, as well as 'surgical' interventions have also been known for a long time. Our current preventive measures are definitively comparable to those of our predecessors. Stone removal, first lithotomy for bladder stones, followed by transurethral methods, was definitively painful and had severe side effects. Then, as now, the incidence of urolithiasis in a given population was dependent on the geographic area, racial distribution, socio-economic status and dietary habits. Changes in the latter factors during the past decades have affected the incidence and also the site and chemical composition of calculi, with calcium oxalate stones being now the most prevalent. Major differences in frequency of other constituents, particularly uric acid and struvite, reflect eating habits and infection risk factors specific to certain populations. Extensive epidemiological observations have emphasized the importance of nutritional factors in the pathogenesis of urolithiasis, and specific dietary advice is, nowadays, often the most appropriate for prevention and treatment of urolithiasis.

First finding of tiemannite, HgSe, in human bladder stones: An electron microprobe study.

Human bladder stones, surgically removed from a 4 years old boy, were studied by X-ray diffraction (XRD) and by electron microprobe analyses (EPMA). XRD data show that the bladder stones are mainly composed of struvite with minor apatite. Tiny particles, <10 µm in size, composed of mercury (Hg) and selenium (Se) were found using scanning electron microscopy (SEM) and quantitative analysis by wave-length dispersive system (WDS). On the basis of their composition, the particles consist of tiemannite, a rare mineral with the ideal formula HgSe. The young patient was not exposed to relevant mercury contamination and has no teeth fillings of amalgam. Although this observation is not conclusive, we suggest that Hg was introduced as methylmercury by food. The discovered tiemannite can be classified as endogenous mineral, i.e., directly precipitated from the same fluids that formed the host bladder stones. This assumption is supported by the fact that tiemannite and struvite can crystallize at the same temperature and pH values. As proposed for the formation of tiemannite previously reported in the liver of cetaceans, we suggest that the tiemannite in the human body represents a probable product of demethylation of Hg. In this contribution, we suggest that Hg and Se were initially collected by urine in the human body and finally precipitated to form tiemannite under appropriate chemical-physical conditions together with the formation of the host bladder stone. This observation suggests that the precipitation and accumulation of metals, including Hg and Se, in the human body can be considered a physiological response to eliminate part of these trace elements, thus enabling detoxification.

Jackstone Calculus.

Jackstone calculus is a rare bladder stone with a unique appearance, presenting a stippled and spiculated contour. Correct diagnosis is important because it may have therapeutic implications, as this distinctive shape correlates with a specific mineral composition of calcium oxalate dihydrate, which tend to be easily fragmented by lithotripsy, allowing to attempt an endoscopic treatment instead of surgery in larger stones. We present the case of a 77-year-old male where a 2 cm bladder calculus was incidentally found on CT, with features that allowed to make straightforward the diagnosis of a jackstone calculus.

Local factors compared with systemic factors in the formation of bladder uric acid stones.

AIM: The aim of this study was to evaluate the clinical characteristics of uric acid urolithiasis and how the presentation differs between urolithiasis of the upper urinary tract (UUT) compared with urolithiasis of the bladder. We attempted to evaluate the importance of local vs. systemic factors in the formation of bladder uric acid stones. PATIENTS AND METHODS: The medical records of 77 consecutive patients with uric acid urolithiasis from January 2004 to December 2006 were reviewed retrospectively. In all patients, histories were recorded, and physical examinations, renal function tests and urine analysis were done. The features of the treated stones were recorded, and the chemical composition was analyzed by computed Fourier transform infrared spectrophotometry. RESULTS: Among 77 patients with uric acid stones, 66 were male and 11 were female (ratio of 7.6:1). Mean age was 59.50 +/- 10.46 years. Of the stones, 55 (71.4%) were located in the UUT (UUT group) and 22 (28.6%) in the bladder (bladder group). Multiple presentations of urolithiasis at diagnosis were found in 56 (72.7%) patients. The mean values of serum creatinine and uric acid were 148.28 +/- 70.69 and 443.33 +/- 95.91 micromol/l, respectively. Mean body mass index (BMI) was 26.78 +/- 2.90, and 72.7% of patients were overweight or obese. Mean urinary pH was 5.39. No significant differences existed between the 2 groups in regard to gender, BMI, urinary pH, stone nature, or presence of hypertension, gout, and/or urinary tract infections. In the bladder group, the incidence of benign prostate hyperplasia was significantly increased, and the incidence of diabetes mellitus was significantly lower, as were levels of serum uric acid and creatinine. CONCLUSIONS: Uric acid urolithiasis was predominant in men in this study. These patients tended to be obese or overweight, with multiple stone presentations and low urinary pH. Furthermore, the bladder uric acid stone group had significantly lower levels of serum creatinine and uric acid, and lower percentages of diabetes mellitus but higher incidences of benign prostate hyperplasia in comparison with the UUT group. The local factor seems more important than the systemic factor in the formation of bladder uric acid stone.

[Prevalence and composition of urolithiasis in a pediatric Tunisian population]. / Prévalence et composition de la lithiase urinaire dans une population pédiatrique tunisienne.

OBJECTIVES: The epidemiologic characteristics are significant to take into account in order to determine the etiology of the paediatric urinary calculi. In this study we studied the composition of stones according to the sex and the age. PATIENTS AND METHODS: Our study focuses on 205 tunisian children aged between three months and 16 years, admitted in our service between 1993-2007. A first urinary metabolic balance was conducted among 126 patients. The physical and chemical stones analysis was performed respectively by a stereomicroscope and infrared spectroscopy. Statistical analysis of the results was made using the software SPSS11.0. RESULTS: Bladder stone was present in 30.7%. It was more frequent in infants than children over 10 years (p<0.02). The Whewellite was present in 72.7% and predominant in older children stones (59.3% vs 42.9% in infants) (p<0.05). Purines stones were more common among infants. Struvite has been the major compound in only 7.8% of cases where it was more common in infants (p<0.05) male (p<0001). CONCLUSION: The higher prevalence of calcium oxalate stones and weaker purin ones in old children suggested the presence of different lithogenous factors of risk according to the age. A modification of the food practices is probably in question.

Composition and spatial distribution of elements and isotopes of a giant human bladder stone and environmental implications.

The composition and spatial distribution of minerals, trace elements, as well as carbon and nitrogen isotopes from the outer crust to inner nucleus of a 20-year old giant human bladder stone comprising thirteen layers were intensively investigated. Calcium oxalate monohydrate (COM) was found to concentrate in the inner and middle layers, struvite was concentrated in middle and outer layers, and fluorapatite occurred in almost all layers. The spatial distribution of minerals has the potential to provide preliminary knowledge regarding the long-term urine composition, or even the physiological condition of the patient. The stable carbon isotope ratio (δ13C) and stable nitrogen isotope ratio (δ15N) were measured in each layer and significant correlation was found between δ13C with calcium oxalate monohydrate content and between δ15N and struvite content. Nearly constant values of -23.2‰ and 7.1‰ for δ13C and δ15N, respectively, were found in the organic components of the stone. Both isotope ratios indicate a long-term fixed diet consisting mainly of C3 plants, such as rice and wheat, for the 20-year time period of the stone formation. In addition, eighteen elements (Ca, P, Mg, K, Na, Al, Fe, Zn, Pb, Cu, Sr, Ba, Ti, V, Cr, Ni, Mn and Co) were measured in all the layers. The trace elements Al, Fe, Cu, Zn, Pb, Sr, Ba and Ti showed a similar spatial distribution pattern from the outer crust to the inner core. Although there were complex correlations between elements and minerals, Factor Analysis suggests that the occurrence of these elements in stones may be mainly the result of environmental exposure to metals during the formation of the stone, indicating that urinary stones may serve as potential long-term biomonitors. In particular, Ni and Cr showed a distinct distribution pattern in the stone, which may relate to human metabolic activities.

[Giant bladder stone nine years after neobladder construction: a case report].

Urinary stone formation after orthotopic neobladder construction is a delayed complication. A giant bladder stone was found in a 67-year-old man who had undergone radical cystectomy and orthotopic neobladder substitution (Hautmann method) in 1998. The stone was removed by cystolithotripsy and weighed 108 g.