尿路結石の再発 : 尿石患者700例735結石の分析を基礎として

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Seven hundred patients with urolithiases, treated from l953 through l970, were studied for the stone recurrence. The length of the follow-up period was from 1 year and 0 month to 19 years and 0 month, the mean being 8 years and 8 months. The chemical compositions of 735 urinary calculi from these patients were analysed by infrared spectroscopy. The sites of 735 calculi are shown in Table 1. The age distribution and the sex of 700 patients are shown in Fig, 1-2. Of these 700 patients, 422 cases were possible to follow up; 250 cases have had no further stone, 138 cases experienced recurrent stones and 34 cases had multiple stones (i.e., stones of bilateral upper urinary tracts, or both of upper and lower urinary tracts). The results of survey study on these 422 cases were following; 1) Of 383 patients with upper urinary tract calculi, 163 cases (42.6 per cent) have had their recurrent stones(the cases with multiple calculi included). The percentage recurrunce was 43.6 per cent for males and 40.0 per cent for females. Although the highest incidence of stone recurrence was noticed in 30-39 year and 70-79 year in age, there was no marked difference of stone recurrence at different ages (Fig. 1, Table 2). Of 39 patients with lower urinary tract calculi, 9 cases (23.1 per cent) have had their recurrent stones. The percentage recurrence was 22.9 per cent for males and 25.0 per cent for females (Fig. 2. Table 3). 2) Relationship between the sites of initial stones and the stone recurrence: Percentage recurrence was 34.4 per cent for rt. upper urinary tract calculi, 39.1 per cent for It. upper urinary tract calculi and 23.1 per cent for lower urinary tract calculi (Table 4). 3) Recurrence rates according to stone compositions: 41.2 per cent of the patients with oxalatephosphate calculi, 38.7 per cent of the patients with magnesium ammonium phosphate calculi, 55.6 per cent of the patients with uric acid calculi, 22.2 per cent of the patients with urate calculi and 50.0 per cent of the patients with cystine calculi have had their recurrent stones (Table 5-6). 4) Recurrence rates according to the types of removal of initial stones ware: 12.5 per cent of partial nephrectomy, 16.6 per cent of basket cather, 22.6 per cent of nephrectomy, 30.0 per cent of nephrolithotomy, 30.0 per cent of pyelolithotomy, 38.4 per cent of ureterolithotomy, 59.3 per cent following spontaneous discharges of stones, 13.3 per cent cystolithotomy, 28.6 per cent of cystolitholapaxy and 31.3 per cent of cystolithotripsy (Table 8-9). 5) The averae interval between initial stone and first recurrence was 4 years and 0 month. Most of recurrence occured in 1-2 years following the removal of initial stones (Table 10). 6) The times of recurrences: 70.3 per cent of patients with recurrent stones have had only one recurrence and 5.8 per cent of patients have had frequent recurrences of 7 times (Table 11). 7) The urinary excretion values of calcium, magnesium, phosphorous and uric acid in patients with oxalate-phosphate calculi were not different between the patients without recurrence and those with recurrences. However, the ratio of [numerical formula] in urine of the patients with recurrent oxalatephosphate calculi was significantly lower than that in urine of the patients without stone recurrence (Fig. 3, Ttable 13).
1974-07-20

尿路結石の再発 : 尿石患者700例735結石の分析を基礎として

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