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[考虑性别特异性因素的尿石症治疗与复发预防]

[Urolithiasis-Therapy and recurrence prevention taking into account gender-specific aspects].

作者信息

Siener Roswitha, Strohmaier Walter L, Neisius Andreas

机构信息

Universitäres Steinzentrum, Klinik und Poliklinik für Urologie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland.

Medical School Regiomed, Regiomed-Klinikum Coburg, Coburg, Deutschland.

出版信息

Urologie. 2022 Oct;61(10):1076-1082. doi: 10.1007/s00120-022-01912-6. Epub 2022 Aug 26.

Abstract

The prevalence of urolithiasis is steadily increasing worldwide in both genders. Diet and lifestyle, such as the rising prevalence of obesity and other metabolic syndrome traits, are considered key factors in this trend. Gender differences as a result of interventional therapy for urolithiasis have not been observed. However, iatrogenic injury to the male urethra is considered the most common reason for urethral strictures after endourologic (stone) therapy. In contrast, sepsis, as the major cause of urinary stone-related mortality, is more frequently reported in women after ureterorenoscopy and percutaneous nephrolithotomy. There are also differences in the frequency of various types of stones between men and women. Calcium oxalate and uric acid stones are more commonly observed in men, while carbonate apatite and struvite are diagnosed more often in women. Urinary stone analysis is therefore paramount for successful recurrence prevention. Diagnosis is based on the assignment of patients to the low-risk or high-risk group. The medical nutrition and pharmacological measures for the therapy of the respective type of stone are based on the risk factors in 24 h urine samples. A personalized approach that accounts for gender differences could further improve treatment, and recurrence prevention decisions for urinary stones.

摘要

全球范围内,尿石症的患病率在男女两性中都在稳步上升。饮食和生活方式,如肥胖患病率上升及其他代谢综合征特征,被认为是这一趋势的关键因素。尚未观察到尿石症介入治疗导致的性别差异。然而,医源性男性尿道损伤被认为是腔内(结石)治疗后尿道狭窄的最常见原因。相比之下,作为尿石症相关死亡的主要原因,脓毒症在女性输尿管镜检查和经皮肾镜取石术后的报告更为频繁。男女之间各种类型结石的发生率也存在差异。草酸钙结石和尿酸结石在男性中更常见,而碳酸磷灰石和鸟粪石在女性中诊断更为频繁。因此,尿石分析对于成功预防复发至关重要。诊断基于将患者分为低风险或高风险组。针对各类型结石治疗的医学营养和药理学措施基于24小时尿液样本中的风险因素。考虑性别差异的个性化方法可进一步改善尿石症的治疗及复发预防决策。

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