Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
J Urol. 2011 Dec;186(6):2285-90. doi: 10.1016/j.juro.2011.07.089. Epub 2011 Oct 20.
The 2005 American Urological Association Guideline on the Management of Staghorn Calculi suggests that metabolic stones are uncommon in the composition of staghorn calculi. We determined the incidence and treatment outcomes of metabolic stones in patients with complete staghorn calculi compared to infection stones in those undergoing percutaneous nephrolithotomy.
We retrospectively analyzed all patients who underwent percutaneous nephrolithotomy for complete staghorn calculi between April 2005 and April 2010. Stone analysis was reviewed to classify stone type as infectious or metabolic. Perioperative characteristics and patient outcomes were compared in relation to stone composition.
Of 52 kidneys (48 patients) with complete staghorn calculi 29 (56%) were metabolic and 23 (44%) were infection stones. Stone compositions in the metabolic group were calcium phosphate (55%), uric acid (21%), calcium oxalate (14%) and cystine (10%). Patients with metabolic stones were more likely male (55% vs 17%, p = 0.005) and more likely to have a negative preoperative urinary culture (62% vs 35%, p = 0.05). Patients with metabolic stones had a lower complication rate (p = 0.02), while those with infection stones tended to require additional access and secondary treatment, and to have higher recurrence rates. Multiple urinary metabolic abnormalities were noted in all 13 (48%) patients with metabolic stones who completed evaluation.
In a contemporary cohort of patients, metabolic stones comprised a large proportion of complete staghorn calculi. In our series calcium phosphate was the most common stone composition noted. Metabolic stones should be considered during the evaluation of staghorn calculi, and our results underscore the importance of stone analysis and subsequent metabolic evaluation in these patients.
2005 年美国泌尿外科学会关于鹿角结石处理的指南表明，代谢性结石在鹿角结石的成分中并不常见。我们比较了经皮肾镜碎石取石术（PCNL）治疗完全鹿角结石患者中代谢性结石和感染性结石的发生率和治疗结果。
我们回顾性分析了 2005 年 4 月至 2010 年 4 月期间所有接受 PCNL 治疗完全鹿角结石的患者。回顾结石分析结果，将结石类型分为感染性或代谢性。比较结石成分与围手术期特征和患者结局的关系。
52 个肾脏（48 例患者）中有 29 个（56%）为代谢性结石，23 个（44%）为感染性结石。代谢性结石组的结石成分分别为磷酸钙（55%）、尿酸（21%）、草酸钙（14%）和胱氨酸（10%）。代谢性结石患者更可能为男性（55%比 17%，p = 0.005），术前尿培养更可能为阴性（62%比 35%，p = 0.05）。代谢性结石患者的并发症发生率较低（p = 0.02），而感染性结石患者更倾向于需要额外的通道和二次治疗，且复发率更高。在所有完成评估的 13 例（48%）代谢性结石患者中均发现多种尿代谢异常。
在当代患者队列中，代谢性结石构成了大部分完全鹿角结石。在我们的系列中，磷酸钙是最常见的结石成分。在评估鹿角结石时应考虑代谢性结石，我们的结果强调了在这些患者中进行结石分析和随后的代谢评估的重要性。
