MECHANISM OF STONE FORMATION - 11/09/11

Doi : 10.1016/S0094-0143(05)70350-5

K.C. Balaji, MD ^{^{*
From Division of Urology, Department of Surgery, University of Massachusetts Medical Center, Worcester, Massachusetts}}, Mani Menon, MD ^{^{*
From Division of Urology, Department of Surgery, University of Massachusetts Medical Center, Worcester, Massachusetts}}

Résumé

Urinary stone disease has afflicted humankind since antiquity. A bladder stone was found in an Egyptian skeleton more than 7000 years old.^{7 Deganello S., Coe F.L. Epitaxy between uric acid and whewellite. Experimental verification N Jb Miner Mh 1983 ; H-6 : 270-276

Cliquez ici pour aller à la section Références} Urolithiasis is a common disorder affecting 1% to 5% of the population in industrialized countries with a lifetime risk of 20% in white men and 5% to 10% in women.^{35 Pak C.Y., Ohata M., Lawrence E.C. , et al. The hypercalciurias: Causes, parathyroid functions and diagnostic criteria J Clin Invest 1974 ; 54 : 387 [cross-ref]

Cliquez ici pour aller à la section Références} The recurrence rate without treatment for calcium oxalate renal stones is 10% at 1 year, 35% at 5 years, and 50% at 10 years.^{51 Tiselius H.G., Larsson L. Calcium phosphate: An important crystal phase in patients with recurrent calcium stone formation? Urol Res 1993 ; 18 : 175-180 [cross-ref]

Cliquez ici pour aller à la section Références} In the United States, urolithiasis accounted for 0.9% of hospital discharges with a mean stay of 3 days, costing 1.83 billion dollars in 1993.^{3 Bushinsky D.A., Kreiger N.S. Integration of calcium metabolism in the adult Disorders of Bone and Mineral Metabolism New York: Raven Press (1992).

Cliquez ici pour aller à la section Références} An understanding of the mechanism of stone formation helps to manage patients better, thereby significantly reducing the morbidity and health care costs associated with urolithiasis. In this article the authors discuss the physical basis of stone formation followed by the pathophysiology of the various types of urinary stones.

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Plan

PHYSICAL CONCEPTS

Saturation, Supersaturation, and Ksp

Summary of Physical Aspects of Urolithiasis

MECHANISM OF FORMATION OF VARIOUS TYPES OF STONES

Calcium Oxalate Stones

Struvite Stones

Uric Acid Stones

Pure Calcium Phosphate Stones

Cystine Stones

Miscellaneous Stones

CONCLUSION

Address reprint requests to K.C. Balaji, MD, Division of Urology, Department of Surgery, University of Massachusetts Medical Center, 55 Lake Avenue North, Worcester, MA 01655