Department of Urology, College of Medicine, Chungbuk National University, Cheongju, Republic of Korea.
Department of Urology, Wonkwang University Sanbon Hospital, Gunpo, Republic of Korea.
Urology. 2014 Aug;84(2):274-8. doi: 10.1016/j.urology.2014.02.029. Epub 2014 Apr 24.
To characterize the clinical and metabolic abnormalities of patients presenting with multiple stones and determine their risk of new stone formation.
This retrospective case-controlled study consisted of 911 patients who had ureter stones for the first time and 107 age- and sex-matched patients without stones. The patients were classified into 2 groups: those with a single ureter stone (n = 690) and those with 1 or more additional stones somewhere in the ureter or kidney (n = 221). All patients underwent 24-hour urinary metabolic evaluation. The 240 patients (26.3%) who were followed for >12 months (median follow-up, 35.0 months) were included in recurrence analyses. Stone recurrence was defined as "new stone formation," namely, the radiographic appearance of stones that had not been present in previous examinations.
The multiple-stone group had significantly lower urinary citrate excretion than the single-stone (P = .011) and control (P = .003) groups. Compared with the single-stone group, it also had a higher incidence of hypocitraturia (P = .011) and stone recurrence (27 of 84 [32.1%] vs 29 of 156 [18.6%] patients; P = .025). Multivariate Cox regression analyses revealed that stone multiplicity (hazard ratio, 2.343; 95% confidence interval, 1.302-4.220; P = .005) was an independent predictor of recurrent stone formation. Kaplan-Meier curves showed identical results.
The patients with multiple stones had distinct metabolic characteristics, particularly hypocitraturia and a significantly higher risk of recurrence than patients with 1 stone. Patients with multiple stones, even if it is their first stone episode, should undergo metabolic evaluation and possibly also potassium citrate therapy to prevent future stones.
描述多发性结石患者的临床和代谢异常情况，并确定其新发结石形成的风险。
本回顾性病例对照研究纳入了首次出现输尿管结石的 911 例患者和 107 例年龄和性别匹配的无结石患者。患者分为两组：单发输尿管结石组（n=690 例）和 1 个或多个输尿管或肾脏内其他部位结石组（n=221 例）。所有患者均接受 24 小时尿液代谢评估。对 240 例（26.3%）随访时间>12 个月（中位随访时间 35.0 个月）的患者进行复发分析。结石复发定义为“新发结石形成”，即先前检查中未出现的结石的影像学表现。
多发性结石组的尿枸橼酸排泄明显低于单发结石组（P=0.011）和对照组（P=0.003）。与单发结石组相比，多发性结石组还具有更高的低枸橼酸尿发生率（P=0.011）和结石复发率（84 例中有 27 例[32.1%]，156 例中有 29 例[18.6%]；P=0.025）。多因素 Cox 回归分析显示，结石多发性（风险比，2.343；95%置信区间，1.302-4.220；P=0.005）是结石复发的独立预测因素。Kaplan-Meier 曲线也显示了相同的结果。
多发性结石患者具有独特的代谢特征，特别是低枸橼酸尿症，其复发风险明显高于单发结石患者。即使是首次发作结石的患者，多发性结石患者也应进行代谢评估，并且可能还需要枸橼酸钾治疗，以预防未来的结石形成。
