Filler Guido, Dave Sumit, Ritter Victor, Ross Sherry, Viprakasit Davis, Hatch Joseph E, Bjazevic Jennifer, Burton Jeremy, Gilleskie Donna, Gilliland Jason, Lin Feng-Chang, Jain Nina, McClure J Andrew, Razvi Hassan, Bhayana Vipin, Wang Peter, Coulson Sherry, Sultan Nabil, Denstedt John, Fearrington Loretta, Diaz-Gonzalez de Ferris Maria E
Department of Paediatrics, Western University, London, ON, Canada.
Department of Medicine, Western University, London, ON, Canada.
Front Med (Lausanne). 2023 Oct 23;10:1272900. doi: 10.3389/fmed.2023.1272900. eCollection 2023.
Urinary stone disease (USD) historically has affected older men, but studies suggest recent increases in women, leading to a near identical sex incidence ratio. USD incidence has doubled every 10 years, with disproportionate increases amongst children, adolescent, and young adult (AYA) women. USD stone composition in women is frequently apatite (calcium phosphate), which forms in a higher urine pH, low urinary citrate, and an abundance of urinary uric acid, while men produce more calcium oxalate stones. The reasons for this epidemiological trend are unknown.
This perspective presents the extent of USD with data from a Canadian Province and a North American institution, explanations for these findings and offers potential solutions to decrease this trend. We describe the economic impact of USD.
There was a significant increase of 46% in overall surgical interventions for USD in Ontario. The incidence rose from 47.0/100,000 in 2002 to 68.7/100,000 population in 2016. In a single United States institution, the overall USD annual unique patient count rose from 10,612 to 17,706 from 2015 to 2019, and the proportion of women with USD was much higher than expected. In the 10-17-year-old patients, 50.1% were girls; with 57.5% in the 18-34 age group and 53.6% in the 35-44 age group. The roles of obesity, diet, hormones, environmental factors, infections, and antibiotics, as well as the economic impact, are discussed.
We confirm the significant increase in USD among women. We offer potential explanations for this sex disparity, including microbiological and pathophysiological aspects. We also outline innovative solutions - that may require steps beyond typical preventive and treatment recommendations.
尿路结石病（USD）在历史上主要影响老年男性，但研究表明，近年来女性患者数量有所增加，导致男女性发病率几乎相同。USD的发病率每10年翻一番，在儿童、青少年和青年（AYA）女性中的增长尤为显著。女性USD结石成分通常为磷灰石（磷酸钙），形成于尿液pH值较高、尿枸橼酸盐含量较低且尿酸含量丰富的环境中，而男性则产生更多草酸钙结石。这种流行病学趋势的原因尚不清楚。
本观点文章通过加拿大一个省份和北美一家机构的数据，呈现了USD的发病情况，对这些发现进行了解释，并提出了降低这一趋势的潜在解决方案。我们描述了USD的经济影响。
安大略省USD的总体手术干预量显著增加了46%。发病率从2002年的47.0/10万上升至2016年的68.7/10万人口。在一家美国机构中，2015年至2019年期间，USD每年的独特患者总数从10,612人增加到17,706人，女性USD患者的比例远高于预期。在10至17岁的患者中，50.1%为女孩；18至34岁年龄组中这一比例为57.5%，35至44岁年龄组中为53.6%。文中讨论了肥胖、饮食、激素、环境因素、感染、抗生素的作用以及经济影响。
我们证实了女性USD患者数量的显著增加。我们对这种性别差异提供了潜在解释，包括微生物学和病理生理学方面。我们还概述了创新解决方案——这可能需要采取超出典型预防和治疗建议的措施。
