Endoscopic and Pathologic Characterization of Papillary Architecture in Struvite Stone Formers

Urology
Christopher D JaegerAmy E Krambeck

Abstract

To describe the endoscopic characteristics of renal papillae in struvite stone formers (SFs). From 2009 to 2014, patients undergoing percutaneous nephrolithotomy were prospectively enrolled in our study. Endoscopic analysis and biopsy of papillae were performed to demonstrate the presence and percentage surface area (SA) of Randall's plaque or ductal plug. Comparison with idiopathic calcium oxalate (CaOx) SF and non-SF controls was performed. We identified 29 struvite SFs to compare with 90 idiopathic CaOx SFs and 17 controls. On endoscopic mapping, 28 struvite SFs (97%) demonstrated Randall's plaque and 9 (31%) had plugging. The average mean SA of Randall's plaque in struvite SF (1.5 ± 1.4%) was less than CaOx SFs (3.7 ± 4.3%, P  =  .0018) and similar to controls (1.7 ± 2.7%, P  =  .76). Average mean plug SA was similar between struvite SFs, CaOx SFs, and controls. On metabolic assessment, 83% of struvite SFs had at least one urine abnormality, with urinary uric acid and oxalate levels significantly higher among struvite SFs compared to controls (P  =  .002). Despite lack of active urinary tract infection, interstitial inflammation was more prevalent in struvite SFs compared to CaOx SFs (43.5% vs 7.3%, P  =  .0001). Our findin...Continue Reading

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Citations

Aug 24, 2016·Nature Reviews. Urology·Michael S BorofskyJames E Lingeman
May 31, 2018·International Urology and Nephrology·Saritha RanabothuBeth A Drzewiecki
Dec 28, 2019·Journal of Endourology·Andrew P EvanJames E Lingeman
Jan 6, 2019·World Journal of Urology·Maria Sloth PlessPalle Jörn Sloth Osther
Nov 25, 2018·Nature Reviews. Urology·Erika J Espinosa-OrtizRobin Gerlach
Nov 8, 2020·Nature Reviews. Urology·Ashley AlfordJody Lulich
Jul 3, 2021·Journal of Clinical Medicine·Christophe Almeras On Behalf Of The Lithiasis Committee Of The French Urological Association

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