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Management of high recurrent urolithiasis patients: the long term interdisciplinary approach is the key


Urology & Nephrology Open Access Journal
Isabelle Tostivint MD,1 Vincent Castiglione MD,2 Laurence Pieroni MD,3 PhD, Pierre Conort SurgD,4 Marie-Paule Dousseaux,5 Christine Bonnal,1 Raphaëlle Renard-Penna MD PhD,6 Rachida Inaoui MD,7 Corinne Isnard-Bagnis MD,1 PhD, Etienne Cavalier MD,2 PhD, Hassan Izzedine MD, PhD8

Abstract

Background: Urolithiasis is a pathology that can be highly recurrent, leading to frequent urological interventions, even with specific management. Objective: We want to verify, whether an interdisciplinary long-term approach during a single day-care program decreases the recurrences rate requiring urological intervention.
Design, Setting, and participants: Patients with recurrent stone events were included in a prospective study of 18 months of interdisciplinary management. During the first day (T0), a team of health professionals diagnoses the lithogenic process and analyzes the causes of recurrences to determine preventive measures. Then, patients were re-evaluated at 6 and 18 months later to check the recurrences of stone events and the efficacy of preventive measures. Primary endpoints were urological intervention and urinary tract infection rates at baseline and 6 and 18–months. Secondary endpoints were blood and urine parameters changes and quality of life assessed by an open-ended survey.
Outcome measurements and statistical analysis: the rate of recurrence and urological intervention was checked before the interdisciplinary day (T0) and at 18 months (T18). Blood and urine samples were analyzed to evaluate the lithogenic process, such as the 24h urine, morning urine, and eGFR. Statistical analyses were performed with Statistica 10.
Results and limitations: Out of 157 patients included in the study between 2007 and 2010, 82 (52%) came back 18 months later. After 18 months, 83% did not show any recurrences. The frequency of surgical intervention was 0.65(0.21-1.42) intervention per year before the management and reach 0(0-0) after 18 months (p<0.0001). The 24h diuresis volume was improved from 2.00 (1.50-2.50) to 2.33(1.80-3.05) L/d (p<0.01). Initial extreme values of pH have shown a significant improvement for both initial acid (<5.5, p<0.001), and alkaline (>6.5, p<0.01) pH. Modification of Diet in Renal Disease (MDRD) was stable (81+-23 VS 80+-22 ml/min/1.73m2 (p>0.05)). However, all parameters of 24h urine, as calciuria and oxaluria, did not show significant change.
Conclusion: The long-term interdisciplinary management of the recurrent stone former was useful to reduce recurrences and decrease uro-logical intervention.

Keywords

high recurrence, urolithiasis, interdisciplinary management

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