Khoury A E, Salomon M, Doche R, Soboh F, Ackerley C, Jayanthi R, McLorie G A, Mittelman M W
Division of Urology, Hospital for Sick Children, Toronto, Ontario, Canada.
J Urol. 1997 Sep;158(3 Pt 2):1133-7.
We evaluated the role of mucus in urine after bladder augmentation and hypothesize that mucus acts as a possible etiological factor in stone formation.
Mucus was collected via centrifugation from the 24-hour urine specimens of 8 stone forming and 10 nonstone forming patients who were randomly selected from our augmentation population. The mucus and stones were lyophilized, and then analyzed via scanning electron microscopy and energy dispersive x-ray spectrometry for calcium, phosphate, magnesium and sodium. The 24-hour urine collections were also analyzed to determine any metabolic differences between the 2 groups.
Scanning electron microscopy and energy dispersive x-ray spectrometry spectra showed increased calcium, phosphate, and magnesium, and significantly higher (p < 0.05) calcium-to-phosphate ratios in the mucus of stone versus nonstone forming patients. Of the 8 stones examined all had viscous fluid (mucus) centers rich in calcium, phosphate and magnesium. Calcium-to-phosphate ratios in the corresponding mucus recovered from stone centers were similarly high. Urinary citrate levels were low in both groups, and calcium, phosphate and magnesium were within normal ranges.
Mucus appears to have an important role in the genesis of bladder stones after augmentation, possibly acting as a nidus. Metabolic changes following augmentation were similar in stone and nonstone forming populations. Our data suggest that mucous calcium-to-phosphate ratios may be predictive of future stone formation. Furthermore, there may be a benefit in instituting more aggressive measures aimed at clearing mucus from the bladder.
我们评估了膀胱扩大术后尿液中黏液的作用，并推测黏液可能是结石形成的一个病因。
从我们扩大膀胱人群中随机选取8例结石形成患者和10例无结石形成患者的24小时尿液标本，通过离心收集黏液。将黏液和结石冻干，然后通过扫描电子显微镜和能量色散X射线光谱法分析钙、磷、镁和钠的含量。对24小时尿液收集物也进行分析，以确定两组之间的任何代谢差异。
扫描电子显微镜和能量色散X射线光谱图谱显示，结石形成患者黏液中的钙、磷和镁含量增加，钙磷比显著更高（p < 0.05）。在检查的8颗结石中，所有结石都有富含钙、磷和镁的黏性液体（黏液）中心。从结石中心回收的相应黏液中的钙磷比同样很高。两组的尿柠檬酸盐水平都很低，钙、磷和镁在正常范围内。
黏液似乎在膀胱扩大术后膀胱结石的发生中起重要作用，可能作为结石核心。结石形成和无结石形成人群扩大膀胱术后的代谢变化相似。我们的数据表明，黏液钙磷比可能预测未来结石的形成。此外，采取更积极的措施清除膀胱内的黏液可能有益。
