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An experimental study on residual lithiasis after shock wave lithotripsy
A Costa-Bauzá1, J Perelló, B Isern
1Laboratory of Renal Lithiasis Research, Institute of Health Sciences Research (IUNICS), University of Balearic Islands. 07122 Palma of Mallorca, Spain.
Urological Research
|January 6, 2005
Summary
Residual kidney stones after extracorporeal shock wave lithotripsy (ESWL) can regrow. Phytate, a crystallization inhibitor, completely blocked stone regrowth in vitro, suggesting its potential for preventing recurrence.
Area of Science:
- Nephrology
- Urology
- Materials Science
Background:
- Extracorporeal shock wave lithotripsy (ESWL) is a common treatment for kidney stones.
- Residual fragments after ESWL can lead to stone recurrence.
- Understanding the behavior of these residual fragments is crucial for developing effective prevention strategies.
Purpose of the Study:
- To investigate the regrowth of residual calcium oxalate monohydrate (COM) calculi fragments after ESWL.
- To evaluate the efficacy of phytate as a crystallization inhibitor in preventing stone regrowth.
- To analyze the structural characteristics of regrown fragments.
Main Methods:
- In vivo and in vitro studies of regrown COM fragments post-ESWL.
- Analysis using stereoscopic microscopy, infrared spectroscopy, and scanning electron microscopy with energy dispersive X-ray analysis.
- Evaluation of fragment regrowth by weight increase and assessment of phytate's inhibitory effects.
Main Results:
- In vivo regrown COM fragments showed consistent internal structural features.
- In vitro studies confirmed fragment regrowth within 24 hours in normal urine without inhibitors.
- Phytate (1.5 mg/l) completely inhibited COM fragment regrowth; hypercalciuric urine promoted disorganized calcium oxalate dihydrate (COD) crystal formation.
Conclusions:
- Residual COM fragments post-ESWL exhibit significant regrowth potential.
- Crystallization inhibitors, such as phytate, are effective in preventing in vitro regrowth of ESWL fragments.
- These findings highlight the importance of prophylactic therapies in preventing kidney stone recurrence after ESWL.