Renal struvite stones--pathogenesis, microbiology, and management strategies.

Abstract

Infection stones-which account for 10-15% of all urinary calculi-are thought to form in the presence of urease-producing bacteria. These calculi can cause significant morbidity and mortality if left untreated or treated inadequately; optimal treatment involves complete stone eradication in conjunction with antibiotic therapy. The three key principles of treating struvite stones are: removal of all stone fragments, the use of antibiotics to treat the infection, and prevention of recurrence. Several methods to remove stone fragments have been described in the literature, including the use of urease inhibitors, acidification therapy, dissolution therapy, extracorporeal shockwave lithotripsy, ureteroscopy, percutaneous nephrolithotomy (PCNL), and anatrophic nephrolithotomy. PCNL is considered to be the gold-standard approach to treating struvite calculi, but adjuncts might be used when deemed necessary. When selecting antibiotics to treat infection, it is necessary to acquire a stone culture or, at the very least, urine culture from the renal pelvis at time of surgery, as midstream urine cultures do not always reflect the causative organism.

• Authors: Ryan Flannigan, Wai Ho Choy, Ben Chew, Dirk Lange
• Journal: Nature reviews. Urology (Nat Rev Urol) Vol. 11 Issue 6 Pg. 333-41 (Jun 2014) ISSN: 1759-4820 [Electronic] England
• PMID: 24818849 (Publication Type: Journal Article, Review)

Chemical References

• Anti-Bacterial Agents
• Hemostatics
• Magnesium Compounds
• Phosphates
• Struvite
• Urease

Topics

• Algorithms
• Anti-Bacterial Agents (therapeutic use)
• Crystallization
• Drug Therapy, Combination
• Hemostatics (chemistry)
• Humans
• Kidney Calculi (chemistry, diagnosis, etiology, microbiology, therapy)
• Lithotripsy
• Magnesium Compounds (chemistry)
• Nephrostomy, Percutaneous (methods)
• Phosphates (chemistry)
• Struvite
• Treatment Outcome
• Urease (antagonists & inhibitors)
• Ureteroscopy
• Urinary Tract Infections (complications)