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Defining a clinically significant struvite stone: a non-randomized retrospective study.

Amihay Nevo1, Mohammed Shahait2, Anup Shah2

  • 1Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. amihaynevo@gmail.com.

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|March 5, 2019
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Summary

Higher struvite content in kidney stones correlates with increased infection risk, postoperative complications, and recurrence. Struvite stones with over 25% content indicate a higher clinical significance.

Keywords:
InfectionNephrolithiasisPCNLStruviteUreteroscopy

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Area of Science:

  • Nephrology
  • Urology
  • Infectious Diseases

Background:

  • Struvite stones, a type of infection-induced urinary calculus, are associated with urinary tract infections.
  • Understanding the impact of struvite composition on clinical outcomes is crucial for patient management.

Purpose of the Study:

  • To investigate the association between the percentage of struvite in kidney stones and clinical outcomes.
  • To establish a clinically significant threshold for defining struvite stones.

Main Methods:

  • Retrospective analysis of 123 patients undergoing ureteroscopy or PCNL with struvite-containing stones (2012-2017).
  • Patients categorized into four groups based on struvite content (1-25%, 26-50%, 51-75%, 76-100%).
  • Comparison of bacterial profiles, postoperative Systemic Inflammatory Response Syndrome (SIRS) rates, and stone recurrence rates across groups.

Main Results:

  • Higher struvite content correlated with increased rates of positive preoperative urine cultures and specific pathogens like Proteus.
  • Postoperative SIRS incidence significantly increased with higher struvite percentages (2.4% to 47.4%).
  • Elevated struvite content was linked to a higher 2-year stone recurrence rate.

Conclusions:

  • Increased struvite composition in stones is associated with a higher prevalence of urea-splitting bacteria, greater risk of postoperative SIRS, and more frequent recurrence.
  • A struvite content exceeding 25% serves as a clinically significant indicator for defining struvite stones.