Efficacy of oral chemolysis in the management of staghorn uric acid nephrolithiasis

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Abstract

Staghorn nephrolithiasis represents one of the most complex forms of urolithiasis, with treatment approaches remaining a subject of ongoing debate among specialists. This study aims to assess the effectiveness and safety of oral chemolysis using citrate mixtures in treating staghorn urate nephrolithiasis. A prospective, multicenter cohort study was conducted from January 2023 to October 2024 among patients with CT-diagnosed staghorn stones of presumed urate composition (average urine pH ≤ 5.8, average stone density ≤ 650 HU, radiolucent on urogram or topogram) who received oral chemolysis with a citrate mixture containing citric acid, potassium bicarbonate, and sodium citrate («Blemaren»). Patients were recruited from outpatient clinics and hospitals in Moscow.

Results: Of the 49 patients included in the study, 2 were excluded within the first 2 months. Complete stone dissolution was achieved in 30 patients (63.8%), while 17 patients (36.2%) eventually required surgical intervention. Among these, 4 patients (8.5%) achieved complete stone dissolution within 1 month of therapy, 18 patients (38%) within 3 months, and 8 patients (17%) within 6 months. Of the stones removed surgically, 12 (70.6%) were calcium oxalate, and 5 (29.4%) were uric acid stones. Consequently, the proportion of patients with non-calcium oxalate stones who did not achieve complete stone dissolution was 14.3%. Stone density was the only parameter that significantly influenced the likelihood of stone dissolution and the risk of surgical intervention (p<0.05). According to regression analysis, the likelihood of stone dissolution decreased by a factor of 1.012 with each unit increase in stone density, while the risk of surgery increased by a factor of 1.008 under the same conditions.

Conclusions: The results of this study demonstrate that oral chemolysis for staghorn uric acid nephrolithiasis is an effective method and may serve as a viable alternative to surgical treatment, potentially reducing the associated risks of anesthesia and surgery for this patient group.

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About the authors

V. A. Malkhasyan

Russian University of Medicine; Botkin City Clinical Hospital

Author for correspondence.
Email: vigenmalkhasyan@gmail.com
ORCID iD: 0000-0002-2993-884X

M.D., Professor of the Department of Urology, Russian University of Medicine, Head of Urology Department No67

Russian Federation, Moscow; Moscow

H. U. Tunguzbaev

Russian University of Medicine

Email: tunguzbiev.xamzat@bk.ru
ORCID iD: 0009-0009-0575-2782

resident of the Department of Urology

Russian Federation, Moscow

S. A. Pulbere

Pirogov City Clinical Hospital №1

Email: pulpiv@mail.ru
ORCID iD: 0000-0001-7727-4032

Head of the Urological Department

Russian Federation, Moscow

A. R. Gevorkyan

Outpatient Clinic № 212

Email: Ashot_Gevorkyan@mail.com

Urologis

Russian Federation, Moscown Federation

S. O. Sukhikh

Botkin City Clinical Hospital

Email: docsukhikh@gmail.ru
ORCID iD: 0000-0002-3840-0259

Ph. D., urologist

Russian Federation, Moscow

N. K. Gadzhiev

Saint Petersburg State University

Email: nariman.gadjiev@gmail.com
ORCID iD: 0000-0002-6255-0193

MD, Deputy Director for the Medical part (Urology) of the High Medical Technologies Clinic named after N.I. Pirogov

 

Russian Federation, Saint Petersburg

D. Yu. Pushkar

Russian University of Medicine; Botkin City Clinical Hospital

Email: pushkardm@mail.ru
ORCID iD: 0000-0002-6096-5723

Academician of the Russian Academy of Sciences, M.D., Professor, Head of the Department of Urology, Head, Moscow Urological Centre

Russian Federation, Moscow; Moscow

References

  1. Sorokin I., Mamoulakis C., Miyazawa K., et al. Epidemiology of stone disease across the world. World J Urol. 2017;35(9):1301–1320. doi: 10.1007/s00345-017-2008-6.
  2. Kaprin A.D., Apolikhin O.I., Sivkov A.V., et al. Incidence of urolithiasis in the Russian Federation from 2005 to 2020. Experimental and Clinical Urology 2022;15(2)10-17; https://doi.org/10.29188/2222-8543-2022-15-2-10-17. Russian (Каприн А.Д., Аполихин О.И., Сивков А.В., и соавт. Заболеваемость мочекаменной болезнью в Российской Федерации с 2005 по 2020 гг. Экспериментальная и клиническая урология 2022;15(2)10-17; https://doi.org/10.29188/2222-8543-2022-15-2-10-17).
  3. Ma Q., Fang L., Su R., et al. Uric acid stones, clinical manifestations and therapeutic considerations. Postgrad Med J. 2018 Aug;94(1114):458-462. doi: 10.1136/postgradmedj-2017-135332.
  4. Moses R., Pais V.M. Jr, Ursiny M., et al. Changes in stone composition over two decades: evaluation of over 10,000 stone analyses. Urolithiasis. 2015 Apr;43(2):135-9. doi: 10.1007/s00240-015-0756-6.
  5. Liu Y., Chen Y., Liao B., Luo D., Wang K., Li H., Zeng G. Epidemiology of urolithiasis in Asia. Asian J Urol. 2018 Oct;5(4):205-214. doi: 10.1016/j.ajur.2018.08.007.
  6. Ngo Tin C., Assimos Dean G. Uric acid nephrolithiasis: recent progress and future directions. Rev Urol. 2007;9(1):17–27.
  7. Penniston K.L., Sninsky B.C., Nakada S.Y. Preliminary Evidence of Decreased Disease-Specific Health-Related Quality of Life in Asymptomatic Stone Patients. J Endourol. 2016 May;30 Suppl 1:S42-5. doi: 10.1089/end.2016.0074.
  8. Hall PM. Nephrolithiasis: treatment, causes, and prevention. Cleve Clin J Med. 2009 Oct;76(10):583-91. doi: 10.3949/ccjm.76a.09043.
  9. Sakhaee K. Recent advances in the pathophysiology of nephrolithiasis. Kidney Int. 2009 Mar;75(6):585-95. doi: 10.1038/ki.2008.626. Epub 2008 Dec 10.
  10. Jongyotha K., Sriphrapradang C. Squamous Cell Carcinoma of the Renal Pelvis as a Result of Long-Standing Staghorn Calculi. Case Rep Oncol. 2015 Oct 3;8(3):399-404. doi: 10.1159/000440764.
  11. Karki N., Leslie S.W. Struvite and Triple Phosphate Renal Calculi. [Updated 2023 May 30]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024.
  12. Akilov F.A. et al. Intraoperative complications of endoscopic removal of stones from the upper urinary tract. Urologiia. 2013;(2):79–82. Rassian (Акилов Ф.А. и др. Интраоперационные осложнения эндоскопического удаления камней из верхних мочевыводящих путей. Урология. 2013;(2):79–82).
  13. Golovanov S.A. et al. Multipoint analysis of the mineral composition of coralloid stones in the study of the peculiarities of their formation. Experimental and clinical urology. 2017;(3):52–57. Russian (Голованов С.А. и др. Многоточечный анализ минерального состава коралловидных камней в изучении особенностей их формирования. Экспериментальная и клиническая урология. 2017; (3):52–57).
  14. Normand M., Haymann J.P., Daudon M. Medical treatment of uric acid kidney stones. Can Urol Assoc J. 2024 Jun 17. doi: 10.5489/cuaj.8774.
  15. Tsaturyan A., Bokova E., Bosshard P., Bonny O., Fuster D.G., Roth B. Oral chemolysis is an effective, non-invasive therapy for urinary stones suspected of uric acid content. Urolithiasis. 2020 Dec;48(6):501-507. doi: 10.1007/s00240-020-01204-8.
  16. Yanenko E., Khurtsev K., Makarova T. Classification of coralloid nephrolithiasis and algorithm of therapeutic tactics, Proceedings of the IV All-Union Congress of Urologists 1990. С. 600-601. Russian (Яненко Э., Хурцев К., Макарова Т. Классификация коралловидного нефролитиаза и алгоритм лечебной тактики, Материалы IV Всесоюзного съезда урологов 1990. С. 600-601).
  17. Mandel N.S., Mandel G.S. Urinary tract calculus disease in the United States veteran population. II. Geographical analysis of variations in composition. J Urol. 1989;142:1516–1521. doi: 10.1016/s0022-5347(17)39145-0.
  18. Gault M.H., Chafe L. Relationship of frequency, age, sex, calculus weight, and composition in 15,624 calculi: comparison of results for 1980 to 1983 and 1995 to 1998. J Urol. 2000;164:302–307
  19. Abou-Elela A. Epidemiology, pathophysiology, and management of uric acid urolithiasis: A narrative review. J Adv Res. 2017 Sep;8(5):513-527. doi: 10.1016/j.jare.2017.04.005. Epub 2017 Apr 28.
  20. Mattle D., Hess B. Preventive treatment of nephrolithiasis with alkali citrate – a critical review. Urolithiasis 2005;33:73-9. https://doi.org/10.1007/s00240-005-0464-8
  21. Chew B.H., Wong V.K.F., Halawani A., Lee S., Baek S., Kang H., Koo K.C. Development and external validation of a machine learning-based model to classify uric acid stones in patients with kidney stones of Hounsfield units < 800. Urolithiasis. 2023 Sep 30;51(1):117. doi: 10.1007/s00240-023-01490-y.
  22. Zieber L., Creiderman G., Krenawi M., Rothenstein D., Enikeev D., Ehrlich Y., Lifshitz D. A nomogram to predict «pure» vs. «mixed» uric acid urinary stones. World J Urol. 2024 Oct 31;42(1):610. doi: 10.1007/s00345-024-05340-3.

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2. Fig. 1. ROC curve of the logistic regression model

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3. Fig. 2. Cumulative Kaplan-Meier estimate of the number of surgeries performed, censored for patients in whom the stone dissolved.

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