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Authors Best SL, Sivalingam S, Penniston KL, Nakada SY
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Journal J. Endourol. Volume: 29 Issue: 3 Pages: 357-61
Publish Date 2015 Mar
PubMed ID 25025627
Abstract

Stone analysis is not always available, and recent studies reveal interlaboratory reporting differences, suggesting inaccurate reports. We sought to determine whether appropriate medical therapy could be made without stone analysis when imaging, history, and laboratory data were available.One hundred stone formers (SFs) were categorized as calcium oxalate, calcium phosphate, uric acid, or struvite based on a single analysis. Age, gender, body mass index, comorbidities, serum chemistries, 24-hour urine, and imaging information were incorporated into a “Megaprofile.” Radiographic details about patients’ stones were recorded. Attenuation: Size ratios were calculated to predict stone composition. Stone composition data were then withheld and three urologists (S.L.B., S.S., and S.Y.N.) evaluated each Megaprofile, making nutritional and pharmacologic recommendations. Next, a repeat evaluation ensued with stone analyses. Recommendations were compared with the gold standard being those made using stone composition data.Without stone analysis, the panel recommended targeted nutrition therapy in 91% of cases, which remained unchanged once composition was revealed. Medication was prescribed in 68% of cases. Overall, therapy based on the Megaprofile without stone composition data was appropriate 93% of the time. In 7% of cases, therapy was changed after stone composition was revealed. In 21% of patients with recurrent urinary tract infections (UTIs), knowledge of stone composition altered therapy.Medical, laboratory, and radiographic data provide sufficient information to direct both nutritional and pharmacologic therapy in most SFs (93%), but those with recurrent UTIs may derive more benefit from stone analysis prior to directed medical therapy.


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