Low R K, Stoller M L
Department of Urology, University of California at Davis, Sacramento, USA.
J Urol. 1997 Dec;158(6):2062-4. doi: 10.1016/s0022-5347(01)68153-9.
Papillary "Randall's plaques" are theorized to act as nidi for urinary stone formation. The aim of this study was to document the presence, pattern and distribution of Randall's plaques in patients undergoing endoscopic procedures for urinary stone disease.
Patients undergoing either ureteroscopy or percutaneous nephroscopy for removal of urinary stones underwent endoscopic mapping of accessible calices. These patients were compared to a smaller group of patients undergoing endoscopic procedures for conditions unrelated to urinary stone disease. In patients found to have papillary plaques the presence, location and pattern of plaques were recorded. Plaque formation was correlated with patient age and sex, and primary composition of extricated stone.
Endoscopic evidence of papillary Randall's plaques was found in 74% of 57 patients having ureteroscopic (21) or percutaneous (36) stone removal. Of 7 patients having endoscopic procedures for conditions unrelated to urinary stone disease 3 (43%) had evidence of papillary plaques. Plaques were found uniformly throughout all calices and most commonly diffusely scattered over the papillary surface. There was no correlation between patient age or sex and the presence of plaques. The incidence of plaques varied with the primary composition of extracted stones, and was 100% for calcium phosphate and uric acid, 88% for calcium oxalate, 33% for cystine and 20% for struvite. The incidence of papillary plaques was significantly more common in patients with calcium oxalate (88 versus 43%, p = 0.023) and calcium phosphate stones (100 versus 43%, p = 0.009) than patients without a history of urinary stone disease.
The endoscopic incidence of papillary Randall's plaques in patients with urolithiasis varies with the primary composition of formed urinary stones. Randall's plaques are found in the majority of patients with calcium urinary stone disease. Our findings suggest that the presence of papillary plaques is associated with calcium nephrolithiasis and may contribute to the pathogenesis of calcium urinary stones.
理论上认为乳头“兰德尔斑”是尿路结石形成的核心。本研究的目的是记录接受尿路结石病内镜手术患者中兰德尔斑的存在情况、形态及分布。
接受输尿管镜检查或经皮肾镜检查以清除尿路结石的患者接受了可及肾盏的内镜测绘。将这些患者与一小群因与尿路结石病无关的病症而接受内镜手术的患者进行比较。在发现有乳头斑的患者中，记录斑的存在情况、位置和形态。斑块形成与患者年龄、性别以及取出结石的主要成分相关。
在57例接受输尿管镜取石（21例）或经皮肾镜取石（36例）的患者中，74%有乳头兰德尔斑的内镜证据。在7例因与尿路结石病无关的病症而接受内镜手术的患者中，3例（43%）有乳头斑的证据。在所有肾盏中均发现有斑块，最常见的是在乳头表面呈弥漫性散在分布。患者年龄或性别与斑块的存在之间无相关性。斑块的发生率随取出结石的主要成分而异，磷酸钙和尿酸结石患者中斑块发生率为100%，草酸钙结石患者中为88%，胱氨酸结石患者中为33%，磷酸铵镁结石患者中为20%。有草酸钙结石（88%对43%，p = 0.023）和磷酸钙结石（100%对43%，p = 0.009）的患者中乳头斑的发生率显著高于无尿路结石病史的患者。
尿路结石患者中乳头兰德尔斑的内镜发生率随形成的尿路结石的主要成分而异。大多数钙性尿路结石病患者中可发现兰德尔斑。我们的研究结果表明，乳头斑的存在与钙性肾结石有关，可能有助于钙性尿路结石的发病机制。
