Brushite stone disease as a consequence of lithotripsy?

Area of Science:

• Nephrology
• Urology
• Biochemistry

Background:

• The incidence of calcium phosphate (CaP) stone disease, particularly brushite stones, has risen significantly in recent decades.
• Brushite stones present unique challenges in treatment due to their resistance to common lithotripsy methods and tendency for recurrence.

Purpose of the Study:

• To explore the association between brushite stone disease and iatrogenic transformation of calcium oxalate (CaOx) stone disease.
• To review current literature on how treatments like shock wave lithotripsy (SWL) may contribute to brushite stone formation.

Main Methods:

• Literature review of studies investigating brushite stone disease.
• Analysis of the potential link between iatrogenic injury (e.g., SWL) and brushite stone formation.
• Examination of the pathophysiology of urine acidification failure post-injury.

Main Results:

• Brushite stones are increasingly diagnosed and are difficult to treat, often requiring ballistic fragmentation.
• Patients with brushite stones have lower success rates for stone clearance and higher recurrence rates post-intervention.
• Evidence suggests a potential link between SWL treatment and the transformation of CaOx stones to brushite.

Conclusions:

• Iatrogenic injury, particularly from SWL, may lead to impaired urine acidification and subsequent brushite stone formation in susceptible individuals.
• Understanding this iatrogenic transformation is crucial for managing and preventing recurrent brushite stone disease.
• Further research is needed to elucidate the mechanisms and confirm the causal relationship.