Frolova E A, Tsarichenko D G, Saenko V S, Rapoport L M, Glybochko P V
Institute of Urology and Reproductive Health, FGAOU VO I.M. Sechenov First Moscow State Medical University, Moscow, Russia.
Urologiia. 2022 Dec(6):56-60.
Uric acid stones (UA), consisting of uric acid/uric acid dihydrate, occur in 6.1-15.1% of all cases of urolithiasis in industrialized countries. At the same time, the frequency of these stones is directly dependent on age. Thus, the incidence of UA reaches 40% in men over 80 years of age and 27.3% in women over 90 years of age. UA are the only stones that are amenable to dissolution therapy with the use of citrate salts that alkalinize urine pH. A number of authors and European Association of Urology guidelines consider stone dissolution as a first-line therapy in the treatment of patients with UA, both as monotherapy and in combination with surgical procedures.
The results of conservative treatment of 86 patients aged 28 to 78 years with radiolucent ureteral stones ranging in size from 3 to 25 mm and a density of 133 to 728 HU, who underwent 89 courses of stone dissolution therapy from 2011 to 2018, are presented in the article. They had no obstruction or were prestented. There were 52 men (n=55 courses) and 34 women (n=34 courses).
In 78 out of 89 clinical cases (87.6%), stone-free status was obtained within 14 to 181 days. Most often the duration of therapy was 30 days. In 11 (12.4%) cases the treatment was considered ineffective. However, only in 4 (4.5%) patients the stone size did not change, while in 7 (7.9%) cases it decreased. The results of the study suggest the high efficiency of citrate therapy in patients with ureteral stones in case of unobstructed urine outflow (including those with stents), which is comparable to surgical treatment.
尿酸结石（UA）由尿酸/二水合尿酸组成，在工业化国家所有尿路结石病例中占6.1 - 15.1%。同时，这些结石的发病率与年龄直接相关。因此，80岁以上男性尿酸结石的发病率达到40%，90岁以上女性为27.3%。尿酸结石是唯一可用柠檬酸盐使尿液pH值碱化从而进行溶解治疗的结石。许多作者和欧洲泌尿外科学会指南都将结石溶解作为尿酸结石患者治疗的一线疗法，既可以作为单一疗法，也可与手术治疗联合使用。
本文介绍了2011年至2018年期间对86例年龄在28至78岁、患有透光性输尿管结石（结石大小为3至25毫米，密度为133至728 HU）的患者进行89个疗程结石溶解治疗的保守治疗结果。这些患者无梗阻或已置入支架。其中男性52例（55个疗程），女性34例（34个疗程）。
在89例临床病例中，78例（87.6%）在14至181天内实现了无结石状态。治疗时间通常为30天。11例（12.4%）病例的治疗被认为无效。然而，只有4例（4.5%）患者的结石大小未改变，7例（7.9%）患者的结石大小减小。研究结果表明，在尿液流出通畅（包括置入支架的患者）的输尿管结石患者中，柠檬酸盐治疗具有较高的效率，与手术治疗相当。
