Features of urolithiasis recurrence in the Far North regions

Rudenko V.I., Demidko Yu.L., Tsarichenko D.G., Gadzhieva Z.K., Akopyan G.N., Allenov S.N., Grinko S.V.

1) I.M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia; 2) Salekhard District Clinical Hospital, Salekhard, Russia

Aim. To improve the diagnosis and treatment of urolithiasis in the conditions of the Far North.
Materials and methods. The study included 136 patients in whom stone analysis after surgical treatment was done. The patients underwent examination and treatment at Salekhard District Clinical Hospital and Outpatient Department No. 4 of University Clinical Hospital No. 2, Sechenov University. The mean age of the patients was 47.6±11 years. There were 89 men (65.4%) and 47 women (34.6%). Before surgical intervention, stones were located in a calyx in 31 patients (22.8%), in the renal pelvis in 28 (20.6%), in the upper third of the ureter in 17 (12.5%), in the middle third in 9 (6.6%), and in the lower third of the ureter in 51 patients (37.5%). Indications for surgery included frequent episodes of renal colic, hematuria, and chronic calculous pyelonephritis. Preoperatively, 29 patients (21.3%) had recurrent stone formation, whereas in 107 patients (78.7%) the stone was detected for the first time. Extracorporeal shock wave lithotripsy (ESWL) was performed in 24 patients (17.6%), ureteroscopy with lithotripsy in 74 (54.4%), and percutaneous nephrolithotomy in 38 (27.9%). The mineral composition of the stones was characterized by diversity and variability in frequency. In 28 patients (20.6%), the stone consisted of two types of minerals, whereas in 108 (79.4%) it consisted of three types of minerals in different proportions. During the 24-month follow-up period after surgery, no recurrence of stone formation was observed in 45 patients (33.1%), whereas recurrence was diagnosed in 91 patients (66.9%).
Results. Cluster analysis identified four groups of observations that differed in sample size. Cluster 0 was characterized by a high whewellite content (65.612±12.456) with moderate variability of this parameter. The weddellite level in this group was intermediate (31.729±13.551), also with variable values. The key feature of this cluster was the complete absence of postoperative recurrence of urolithiasis: the recurrence rate was 0.000±0.000. Cluster 1 showed the highest whewellite content among all groups (68.798±11.669). At the same time, the weddellite level in this cluster was lower than in cluster 0 and amounted to 24.218±10.583. The most concerning characteristic of this group was the 100% rate of postoperative urolithiasis recurrence (1.000±0.000). Cluster 2 demonstrated the lowest whewellite content among the first three clusters (42.177±16.461), but at the same time had the highest weddellite level (47.983±21.185). In addition, this group showed an increased uric acid content (40.078), exceeding the corresponding values in the other clusters. The risk of urolithiasis recurrence in this group was extremely high: the mean value was 0.971±0.171, corresponding to a recurrence probability of 97.1%. Cluster 3 represented a distinct subgroup, the smallest one, with only 4 observations, and was characterized by a zero standard deviation. Its distinguishing feature was a markedly elevated level of uric acid dihydrate (30.000), which was 2-2.5 times higher than in the other groups. At the same time, the ammonium urate content (20.000) in this subgroup was lower than in the remaining patients.
Conclusion. The course of urolithiasis is determined by the mineral composition of stones. The four-cluster model clearly demonstrated that the probability of recurrence after surgical treatment is associated with the ratio of mineral components within the calculi. Adaptation of these strategies to the harsh conditions of the Far North is of particular importance. Limited sunlight exposure, extreme temperatures, restricted access to fresh foods, and the remoteness of populated areas require careful control of hydration status, correction of vitamin D deficiency, implementation of telemedicine support, and consideration of local dietary traditions when developing dietary recommendations.

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About the Authors

Corresponding author: Yu.L. Demidko – Ph.D., MD, Urologist, Institute of Urology and Human Reproductive Health, I.M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia; e-mail: demidko1@mail.ru

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