Ahlawat R, Goel M C, Elhence A
Sanjay Gandhi Postgraduate Institute of Medical Sciences, Department of Urology, Uttar Pradesh, India.
Natl Med J India. 1996 Jan-Feb;9(1):10-12.
The spectrum of urinary stone disease has changed considerably in India from the common childhood bladder stone to the more frequent upper tract calculi. We analysed the gravel retrieved from the upper urinary tract using X-ray diffraction analysis in an attempt to evaluate the composition of the stones.
We analysed 434 upper urinary tract calculi from May 1993 to June 1994 obtained endourologically, as well as by extracorporeal shock wave lithotripsy and open surgery. The stones were analysed using a Phillips compact X-ray diffractometer (PW1840). The PC-APD software was used for data collection and peak search. The phase matching was done by the software using the JCPDS reference database.
Oxalate stones comprised 97% of the total stones with calcium oxalate monohydrate forming 90% and calcium oxalate dihydrate and mixed stones forming the remainder. Struvite stones were found in 1.4%, while uric acid and apatite stones were less than 1%. There were no cystine calculi. Seventy per cent of calcium oxalate monohydrate and 40% of calcium oxalate dihydrate stones were pure. All the struvite and apatite calculi were almost pure. Only 15% of staghorns did not consist of oxalate. Nine of the ten stones in children were of the calcium oxalate monohydrate variety. The stone composition in females was similar to that in males.
X-ray diffraction data indicate that urinary stone disease in north India is different from that in the western world. Calcium oxalate monohydrate stones predominate. These stones are hard to break and have a different metabolic origin from those consisting of calcium oxalate dihydrate. These findings might help in selecting the most appropriate method of treatment in north India and they indicate directions in which further metabolic studies might be planned.
在印度，尿路结石疾病谱已发生显著变化，从常见的儿童膀胱结石转变为更常见的上尿路结石。我们使用X射线衍射分析对上尿路取出的碎石进行分析，以评估结石的成分。
我们分析了1993年5月至1994年6月通过腔内泌尿外科手术、体外冲击波碎石术和开放手术获得的434颗上尿路结石。使用飞利浦紧凑型X射线衍射仪（PW1840）对结石进行分析。PC - APD软件用于数据收集和峰搜索。软件使用JCPDS参考数据库进行相匹配。
草酸盐结石占结石总数的97%，其中一水草酸钙占90%，二水草酸钙和混合结石占其余部分。发现磷酸铵镁结石占1.4%，而尿酸和磷灰石结石少于1%。没有胱氨酸结石。70%的一水草酸钙结石和40%的二水草酸钙结石是纯的。所有磷酸铵镁和磷灰石结石几乎都是纯的。只有15%的鹿角形结石不含草酸盐。儿童的十颗结石中有九颗是一水草酸钙类型。女性的结石成分与男性相似。
X射线衍射数据表明，印度北部的尿路结石疾病与西方世界不同。一水草酸钙结石占主导。这些结石难以破碎，其代谢起源与二水草酸钙结石不同。这些发现可能有助于在印度北部选择最合适的治疗方法，并为进一步的代谢研究指明方向。
