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Study of infective (secondary) renal calculus formation in vitro
Abstract:
The factors of infective calculus formation and the conditions favoring their prevention were studied by examining in vitro the role of the most common representative of urease-producing bacteria, Proteus mirabilis. The stream of Proteus-containing urine was found to form deposits of magnesium ammonium phosphate, carbonate apatite and ammonium-urate on the glass surfaces. Application either of mandelic acid or of Gentamycin was found to reduce the production of these deposits, and their joint application proved fully preventive to their formation. Gentamycin applied in saline acidified with mandelic acid was capable of dissolving previously formed crystals. A medication of this composition is advocated for preventive use after surgery for staghorn calculi. The necessity for continuing peroral medication and specific antibacterial therapy for months is emphasized.
Insights
This study shows that combining mandelic acid and Gentamycin prevents the formation of urinary stones caused by Proteus mirabilis bacteria. This combination can also dissolve existing crystals, aiding post-surgery recovery for staghorn calculi patients.
Area of Science:
- Urology
- Microbiology
- Biochemistry
Background:
- Infective calculus formation is a significant clinical challenge.
- Urease-producing bacteria, such as Proteus mirabilis, play a key role in calculus development.
- Understanding prevention strategies is crucial for patient outcomes.
Purpose of the Study:
- To investigate the role of Proteus mirabilis in infective calculus formation.
- To evaluate the efficacy of mandelic acid and Gentamycin in preventing and treating calculus deposits.
- To determine optimal therapeutic strategies for staghorn calculi.
Main Methods:
- In vitro examination of Proteus mirabilis in urine streams.
- Analysis of calculus deposit composition (magnesium ammonium phosphate, carbonate apatite, ammonium-urate).
- Assessment of mandelic acid and Gentamycin efficacy, individually and in combination.
Main Results:
- Proteus mirabilis promoted the formation of magnesium ammonium phosphate, carbonate apatite, and ammonium-urate deposits on glass surfaces.
- Both mandelic acid and Gentamycin reduced deposit formation.
- The combined application of mandelic acid and Gentamycin completely prevented deposit formation.
- Gentamycin in acidified saline dissolved pre-formed crystals.
Conclusions:
- Combined therapy with mandelic acid and Gentamycin is effective in preventing calculus formation.
- This combination shows potential for dissolving existing urinary crystals.
- A medication combining these agents is recommended for preventing staghorn calculi recurrence post-surgery.
- Prolonged peroral and antibacterial therapy is necessary for sustained prevention.