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Papillary Ductal Plugging is a Mechanism for Early Stone Retention in Brushite Stone Disease
- Source :
- Journal of Urology. 199:186-192
- Publication Year :
- 2018
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2018.
-
Abstract
- Mechanisms of early stone retention in the kidney are under studied and poorly understood. To date attachment via Randall's plaque is the only widely accepted theory in this regard, which is best described in idiopathic calcium oxalate stone formers. Brushite stone formers are known to have distinct papillary morphology relative to calcium oxalate stone formers. As such we sought to determine whether stone attachment mechanisms in such patients may be similarly unique.Patients undergoing percutaneous and or ureteroscopic procedures for stone removal consented to endoscopic renal papillary examination and individual stone collection. Each removed stone was processed using micro computerized tomography to assess the 3-dimensional microstructure and the minerals contained, and search for common structural features indicative of novel mechanisms of early growth and attachment to renal tissue.A total of 25 intact brushite stones were removed from 8 patients and analyzed. Video confirmed attachment of 13 of the 25 stones with the remainder believed to have been accidently dislodged during the procedure. Microscopic examination by light and computerized tomography failed to show evidence of Randall's plaque associated with any stone containing brushite. Conversely each brushite stone demonstrated microstructural evidence of having grown attached to a ductal plug formed of apatite.Three-dimensional analysis of small brushite stones suggests overgrowth on ductal apatite plugs as a mechanism of early stone growth and retention. Such findings represent what is to our knowledge the initial supporting evidence for a novel mechanism of stone formation which has previously been hypothesized but never verified.
- Subjects :
- Calcium Phosphates
Male
medicine.medical_specialty
Percutaneous
Urology
medicine.medical_treatment
030232 urology & nephrology
Calcium oxalate
Nephrolithotomy, Percutaneous
Article
Kidney Calculi
03 medical and health sciences
chemistry.chemical_compound
Imaging, Three-Dimensional
0302 clinical medicine
Apatites
Ureteroscopy
medicine
Humans
Brushite
Percutaneous nephrolithotomy
Stone disease
medicine.diagnostic_test
business.industry
Middle Aged
Surgery
chemistry
030220 oncology & carcinogenesis
Female
Stone removal
Stone formers
Tomography, X-Ray Computed
business
Subjects
Details
- ISSN :
- 15273792 and 00225347
- Volume :
- 199
- Database :
- OpenAIRE
- Journal :
- Journal of Urology
- Accession number :
- edsair.doi.dedup.....40998925a57cf88a738903fac2edb2ee