Sex disparities of urolithiasis: epidemiological features and possible causes

Kamalov A.A., Nesterova O.Yu., Panferov A.S., Strigunov A.A., Tereshina A.D., Neftulaev R.R., Kaknaeva P.V.

1) University Clinic, Medical Scientific and Educational Institute, Lomonosov Moscow State University. Moscow, Russia; 2) Faculty of Fundamental Medicine, Medical Scientific and Educational Institute, Lomonosov Moscow State University, Moscow, Russia; 3) Urology center of the «Medassist» medical center, Medscan group, Kursk, Russia; 4) SouthWest State University, Kursk, Russia

This review examines in detail the epidemiology of urolithiasis in men and women, as well as possible mechanisms explaining the gender inequality of urolithiasis. Urolithiasis is one of the most common and socially significant diseases of the urinary system, characterized by a chronic recurrent course with a recurrence rate of about 50% within 5 years after manifestation. Male gender is a significant risk factor for urolithiasis, which is confirmed by numerous studies demonstrating that the prevalence of urolithiasis among men is significantly higher than among women in almost all age categories. At the same time, women have a continuously increasing chance of developing urolithiasis with age, while men have a different tendency. In men, the chances of having urolithiasis increase until the age of 53, and then gradually decrease with increasing age. The physiological basis explaining the gender characteristics of urolithiasis may be differences in the hormonal status of men and women due to the effects on various molecular mechanisms. It is believed that androgens are stimulators of crystal and stone formation due to increased synthesis of oxalates in the liver, increased oxidative stress of the renal parenchyma, increased necrosis and apoptosis of the epithelium of the renal tubules, as well as regulation of the expression of stone matrix proteins. Estrogens, on the contrary, act as inhibitors of crystallization and stone formation by reducing the severity of oxidative stress of the renal parenchyma, reducing the synthesis of oxalates in the liver against the background of modulation of specific enzymes, as well as reducing the expression of receptors for calcium oxalate crystals. Such hormonal features in women are characterized by an increased risk of urolithiasis during menopause after the loss of the protective effect of estrogens. Further research aimed at clarifying more precise mechanisms of the influence of sex hormones on stone formation processes can become the basis for the development of effective strategies for the prevention of urolithiasis, as well as the creation of expanded screening programs based on a gender-oriented approach.

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About the Authors

Corresponding author: O.Yu. Nesterova – M.D., Cand. Sc. (Med), Urologist, Researcher, Urology and Andrology Unit, University Clinic, Medical Scientific and Educational Institute, Lomonosov Moscow State University, senior lecturer of the Dept. of Urology and Andrology, Faculty of Fundamental Medicine, Medical Scientific and Educational Institute, Lomonosov Moscow State University, Moscow, Russia; e-mail: oy.nesterova@gmail.com

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