Profile of the brushite stone former

Amy Krambeck, Shelly E. Handa, Andrew Evan, James E. Lingeman

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

Purpose: The incidence of brushite stones has increased during the last 3 decades and we report our experience with brushite stone formers. Materials and Methods: From 1996 to 2008 we identified 82 patients with brushite urinary calculi. After institutional review board approval a review of our prospectively collected database was performed. Results: There were 54 (65.9%) male and 28 (34.1%) female stone formers. Mean age was 44 years (range 4 to 84). Prior stone events were reported by 69 (84.1%) patients with 54 (78.3%) having received shock wave lithotripsy. Bilateral calculi were present in 28 (34.1%) patients. Mean stone area was 29.2 mm2 (range 2 to 130). Surgery was performed in 80 patients including 63 (76.8%) percutaneous nephrolithotomy, 8 (9.8%) ureteroscopy, 3 (3.7%) shock wave lithotripsy, and 6 (7.3%) ureteroscopy and percutaneous nephrolithotomy. After primary and secondary procedures 76 (92.7%) patients were rendered stone-free. Metabolic urine studies were available in 45 patients. All patients demonstrated 1 or more abnormalities, with hypercalciuria (greater than 250 mg daily for women and greater than 275 mg daily for men) in 38 (80.9%), urine pH greater than 6.2 in 29 (61.7%), urine volume less than 2 l in 27 (57.4%), hypocitraturia (less than 320 mg daily) in 22 (46.8%), hyperuricosuria (greater than 750 mg daily in women, greater than 800 mg daily in men) in 8 (17%) and hyperoxaluria (greater than 32 mg daily in women and greater than 43 mg daily in men) in 5 (10.6%). Recurrent stone events occurred in 31 (37.8%) patients at a mean of 33 (range 2 to 118) months from treatment. Conclusions: Brushite stone formers are a treatment challenge. Almost a third will present with bilateral stones and the stone burden is sizeable. Nearly 80% of patients report having prior shock wave lithotripsy and recurrent stone events occurred approximately 3 years after treatment. All patients with brushite stones in this cohort had an underlying metabolic abnormality and specifically brushite stones should be heralded as a marker for hypercalciuria. Based on these data we recommend all brushite stone formers undergo 24-hour urine studies and have close long-term followup.

Original languageEnglish
Pages (from-to)1367-1371
Number of pages5
JournalJournal of Urology
Volume184
Issue number4
DOIs
StatePublished - Oct 2010

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Lithotripsy
Urine
Ureteroscopy
Hypercalciuria
Percutaneous Nephrostomy
dibasic calcium phosphate dihydrate
Hyperoxaluria
Urinary Calculi
Research Ethics Committees
Calculi
Therapeutics
Databases
Incidence

Keywords

  • brushite
  • calcium phosphate
  • lithotripsy
  • nephrolithiasis
  • nephrostomy, percutaneous

ASJC Scopus subject areas

  • Urology
  • Medicine(all)

Cite this

Profile of the brushite stone former. / Krambeck, Amy; Handa, Shelly E.; Evan, Andrew; Lingeman, James E.

In: Journal of Urology, Vol. 184, No. 4, 10.2010, p. 1367-1371.

Research output: Contribution to journalArticle

Krambeck, Amy ; Handa, Shelly E. ; Evan, Andrew ; Lingeman, James E. / Profile of the brushite stone former. In: Journal of Urology. 2010 ; Vol. 184, No. 4. pp. 1367-1371.
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abstract = "Purpose: The incidence of brushite stones has increased during the last 3 decades and we report our experience with brushite stone formers. Materials and Methods: From 1996 to 2008 we identified 82 patients with brushite urinary calculi. After institutional review board approval a review of our prospectively collected database was performed. Results: There were 54 (65.9{\%}) male and 28 (34.1{\%}) female stone formers. Mean age was 44 years (range 4 to 84). Prior stone events were reported by 69 (84.1{\%}) patients with 54 (78.3{\%}) having received shock wave lithotripsy. Bilateral calculi were present in 28 (34.1{\%}) patients. Mean stone area was 29.2 mm2 (range 2 to 130). Surgery was performed in 80 patients including 63 (76.8{\%}) percutaneous nephrolithotomy, 8 (9.8{\%}) ureteroscopy, 3 (3.7{\%}) shock wave lithotripsy, and 6 (7.3{\%}) ureteroscopy and percutaneous nephrolithotomy. After primary and secondary procedures 76 (92.7{\%}) patients were rendered stone-free. Metabolic urine studies were available in 45 patients. All patients demonstrated 1 or more abnormalities, with hypercalciuria (greater than 250 mg daily for women and greater than 275 mg daily for men) in 38 (80.9{\%}), urine pH greater than 6.2 in 29 (61.7{\%}), urine volume less than 2 l in 27 (57.4{\%}), hypocitraturia (less than 320 mg daily) in 22 (46.8{\%}), hyperuricosuria (greater than 750 mg daily in women, greater than 800 mg daily in men) in 8 (17{\%}) and hyperoxaluria (greater than 32 mg daily in women and greater than 43 mg daily in men) in 5 (10.6{\%}). Recurrent stone events occurred in 31 (37.8{\%}) patients at a mean of 33 (range 2 to 118) months from treatment. Conclusions: Brushite stone formers are a treatment challenge. Almost a third will present with bilateral stones and the stone burden is sizeable. Nearly 80{\%} of patients report having prior shock wave lithotripsy and recurrent stone events occurred approximately 3 years after treatment. All patients with brushite stones in this cohort had an underlying metabolic abnormality and specifically brushite stones should be heralded as a marker for hypercalciuria. Based on these data we recommend all brushite stone formers undergo 24-hour urine studies and have close long-term followup.",
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N2 - Purpose: The incidence of brushite stones has increased during the last 3 decades and we report our experience with brushite stone formers. Materials and Methods: From 1996 to 2008 we identified 82 patients with brushite urinary calculi. After institutional review board approval a review of our prospectively collected database was performed. Results: There were 54 (65.9%) male and 28 (34.1%) female stone formers. Mean age was 44 years (range 4 to 84). Prior stone events were reported by 69 (84.1%) patients with 54 (78.3%) having received shock wave lithotripsy. Bilateral calculi were present in 28 (34.1%) patients. Mean stone area was 29.2 mm2 (range 2 to 130). Surgery was performed in 80 patients including 63 (76.8%) percutaneous nephrolithotomy, 8 (9.8%) ureteroscopy, 3 (3.7%) shock wave lithotripsy, and 6 (7.3%) ureteroscopy and percutaneous nephrolithotomy. After primary and secondary procedures 76 (92.7%) patients were rendered stone-free. Metabolic urine studies were available in 45 patients. All patients demonstrated 1 or more abnormalities, with hypercalciuria (greater than 250 mg daily for women and greater than 275 mg daily for men) in 38 (80.9%), urine pH greater than 6.2 in 29 (61.7%), urine volume less than 2 l in 27 (57.4%), hypocitraturia (less than 320 mg daily) in 22 (46.8%), hyperuricosuria (greater than 750 mg daily in women, greater than 800 mg daily in men) in 8 (17%) and hyperoxaluria (greater than 32 mg daily in women and greater than 43 mg daily in men) in 5 (10.6%). Recurrent stone events occurred in 31 (37.8%) patients at a mean of 33 (range 2 to 118) months from treatment. Conclusions: Brushite stone formers are a treatment challenge. Almost a third will present with bilateral stones and the stone burden is sizeable. Nearly 80% of patients report having prior shock wave lithotripsy and recurrent stone events occurred approximately 3 years after treatment. All patients with brushite stones in this cohort had an underlying metabolic abnormality and specifically brushite stones should be heralded as a marker for hypercalciuria. Based on these data we recommend all brushite stone formers undergo 24-hour urine studies and have close long-term followup.

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