Kamphuis Guido Maarten, Wouter van Hattum Jons, de Bie Prim, Somani Bhaskar K
Department of Urology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
Department of Clinical Chemistry, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
Transl Androl Urol. 2019 Sep;8(Suppl 4):S448-S456. doi: 10.21037/tau.2019.05.01.
Uric acid (UA) urolithiasis comprises around 5-10% of all stones and can frequently recur. Due to the fact that UA stones form in acidic urine with a pH <5.5, these patients require special attention compared to other stone patients. The international guidelines suggest treatment and metaphylaxis by urinary alkalization. The objective of this review is to critically asses the available evidence concerning the method and efficacy of this treatment modality. A systematic review on the methods of metaphylactic therapy using oral alkalization of UA urolithiasis was conducted by two authors. Evidence was sought using a predefined search strategy in seven different databases. The provided evidence was critically evaluated using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Cochrane collaboration tool for assessing the risk of bias. Twelve manuscripts were included of which one was a randomised trial. They focussed on ways to alkalize urine and its effect on stone recurrence. Because of their methodology and heterogeneity, the evidence is presented in a narrative review. There were differences in medication used for alkalizing urine, ways of monitoring urine pH and evaluating its efficacy. The reported outcomes also differed between studies. There is currently a lack of clear evidence for the method of alkalization of urine and the method of pH measurement. Besides this, for an established treatment modality, there is lack of long term results for the alkalization therapy. In conclusion, urine alkalization is an established treatment modality for the metaphylaxis of UA urolithiasis despite the lack of evidence from high quality studies on the methods of alkalization and its treatment efficacy. The studies published on this topic are scarce and contain notable risks of bias which should be kept in mind when interpreting the stated results.
尿酸（UA）结石约占所有结石的5%-10%，且常常复发。由于UA结石在pH<5.5的酸性尿液中形成，与其他结石患者相比，这些患者需要特别关注。国际指南建议通过尿液碱化进行治疗和预防。本综述的目的是严格评估关于这种治疗方式的方法和疗效的现有证据。两位作者对使用口服碱化治疗UA结石的预防治疗方法进行了系统综述。使用预定义的搜索策略在七个不同的数据库中查找证据。使用系统评价和Meta分析的首选报告项目（PRISMA）以及用于评估偏倚风险的Cochrane协作工具对所提供的证据进行严格评估。纳入了12篇手稿，其中一篇是随机试验。它们关注尿液碱化的方法及其对结石复发的影响。由于其方法和异质性，证据以叙述性综述的形式呈现。用于尿液碱化的药物、监测尿液pH值的方法以及评估其疗效的方式存在差异。不同研究报告的结果也有所不同。目前缺乏关于尿液碱化方法和pH测量方法的明确证据。除此之外，对于一种既定的治疗方式，碱化疗法缺乏长期结果。总之，尽管缺乏关于碱化方法及其治疗效果的高质量研究证据，但尿液碱化是UA结石预防的一种既定治疗方式。关于该主题发表的研究很少，并且存在明显的偏倚风险，在解释所述结果时应牢记这一点。
