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

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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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作者简介

V. Malkhasyan

Russian University of Medicine; Botkin City Clinical Hospital

编辑信件的主要联系方式.
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

俄罗斯联邦, Moscow; Moscow

H. Tunguzbaev

Russian University of Medicine

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

resident of the Department of Urology

俄罗斯联邦, Moscow

S. Pulbere

Pirogov City Clinical Hospital №1

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

Head of the Urological Department

俄罗斯联邦, Moscow

A. Gevorkyan

Outpatient Clinic № 212

Email: Ashot_Gevorkyan@mail.com

Urologis

俄罗斯联邦, Moscown Federation

S. Sukhikh

Botkin City Clinical Hospital

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

Ph. D., urologist

俄罗斯联邦, Moscow

N. 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

 

俄罗斯联邦, Saint Petersburg

D. 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

俄罗斯联邦, Moscow; Moscow

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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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