Thomas J, Thomas E, Fompeydie D, Arvis G, Zerbib M, Bénassayag E, Flam T, Debré B
Service d'Andro-Urologie, Hôpital Tenon, Paris.
J Urol (Paris). 1995;101(3):139-52.
Seventeen cases of urinary calculi analyzed by infrared spectrophotometry were found to be composed entirely or nearly entirely of bihydrated calcium hydrophosphate. The observations are summarized here. This type of stone occurs with a frequency of about 1% (0.85% in our experience) of all urinary calculi, predominantly in men (14 of our 17 cases). Diagnosis is based on the physical and chemical analysis of the stone and on infrared spectrophotometry. Most of these stones are pure or nearly pure compounds. The macroscopic aspect of the stones or fragments of stones can guide diagnosis. These stones are cream coloured stones with a smooth regular outer surface. Broken fragments show the same cream colour, sometimes with strips radiating from the centre of the fracture surface. Radiologically, these stones are homogeneously radio-opaque, often oval-shaped with a regular outline. Blood tests can demonstrate suspected or proven hyperparathyroidism (4 out of 10 cases in our 17 observations) with hypercalcemia, hypophosphatemia and hypercalciuria. Complementary examinations may be needed to search for a parathyroid adenoma. With or without hyperparathyroidism, 24-h urinalysis usually shows hypercalciuria up to ro over 500 to 600 mg/24 h. Crystallization usually occurs in the upper urinary tract, in the bladder or in indwelling catheters. These stones are extremely hard and are difficult to break in vitro. To be successful, lithotripsy requires prolonged treatment: up to 3000 to 6000 shockwaves at 22-23 kv with the Dornier apparatus. Despite the notion of hypercalciuria, the pathogenesis of bihydrated calcium hydrophosphate calculi remains to be elucidated.
通过红外分光光度法分析的17例尿结石病例发现，结石完全或几乎完全由磷酸氢钙二水合物组成。现将观察结果总结如下。这类结石在所有尿结石中出现的频率约为1%（我们的经验为0.85%），主要发生在男性中（我们的17例病例中有14例）。诊断基于结石的物理和化学分析以及红外分光光度法。这些结石大多是纯的或几乎是纯的化合物。结石或结石碎片的宏观外观可指导诊断。这些结石是奶油色的，外表面光滑规则。破碎的碎片呈现相同的奶油色，有时从断裂面中心向外辐射出条纹。在放射学上，这些结石在X线下表现为均匀的不透光，通常呈椭圆形，轮廓规则。血液检查可显示疑似或确诊的甲状旁腺功能亢进（我们的17例观察中有10例中的4例），伴有高钙血症、低磷血症和高钙尿症。可能需要进行补充检查以寻找甲状旁腺腺瘤。无论有无甲状旁腺功能亢进，24小时尿液分析通常显示高钙尿症，高达500至600毫克/24小时以上。结晶通常发生在上尿路、膀胱或留置导管中。这些结石极其坚硬，体外难以破碎。要成功进行碎石术需要长时间治疗：使用多尼尔设备在22 - 23千伏下进行多达3000至6000次冲击波治疗。尽管存在高钙尿症的概念，但磷酸氢钙二水合物结石的发病机制仍有待阐明。
