Contemporary Management of Struvite Stones Using Combined Endourological and Medical Treatment: Predictors of Unfavorable Clinical Outcome.
Introduction: Struvite stones have been associated with significant morbidity and mortality. Yet, there has not been a report on the medical management of struvite stones in almost 20 years. We report on the contemporary outcomes of the surgical and medical management of struvite stones in a contemporary series. Patients and Methods: A retrospective review of patients treated with percutaneous nephrolithotomy (PNL) for struvite stones at Duke University medical center between January 2005 and September 2012 identified a total of 75 patients. Of these, 43 patients had adequate follow up and were included in this analysis. Stone activity, defined as either stone recurrence or stone related events, and predictors of activity were evaluated after combined surgical and medical treatment. Results: The study included 43 patients with either pure (35%) or mixed (65%) struvite stones with a median age 55±15 y (range, 21-89). The stone free rate after PNL was 42%. Stone recurrence occurred in 23% of patients. Postoperatively, 30% of patients had a stone related event, while 60% of residual stones remained stable with no growth after a median follow up of 22 months (range, 6-67). Kidney function remained stable during follow up. Independent predictors of stone activity included the presence of residual stones >0.4 cm2, preoperative large stone burden (> 10 cm2) and the presence of medical co-morbidities (p < 0.05). Conclusions: Struvite stones can be treated safely with PNL followed by medical therapy. The majority of patients with residual fragments demonstrated no evidence of stone growth on medical therapy. With careful follow up and medical management, kidney function can be maintained and stone morbidity can be minimized. Initial large stone burden, residual stones after surgery and associated medical co-morbidities may have deleterious effect on stone recurrence or residual stone related events.
Iqbal, MW; Youssef, R; Neisius, A; Kuntz, N; Hanna, J; Ferrandino, MN; Preminger, GM; Lipkin, ME
Pubmed Central ID
Electronic International Standard Serial Number (EISSN)
Digital Object Identifier (DOI)