title: The efficacy of potassium citrate based medical prophylaxis for preventing upper urinary tract calculi: a midterm followup study.
abstract: OBJECTIVE
  We examined the efficacy of potassium citrate based medical prophylaxis for preventing upper urinary calculous recurrence, and compared it with the stone recurrence rate in patients who only received intermittent or no medical prophylaxis.
  
  
  METHODS
  We retrospectively reviewed the records of 493 patients with upper urinary calculi, of whom 237 men and 76 women with a mean age of 56.1 and 51.4 years, respectively, were enrolled in the study. Of the 313 participants 64 (group 1, 20.4%) received regular medical prophylaxis for 24 to 42 months (mean 27.8), 80 (group 2, 25.6%) received intermittent medical prophylaxis for 1.5 to 19 months (mean 7.9) and 169 (group 3, 54%) did not receive any medical prophylaxis.
  
  
  RESULTS
  At midterm followup of 24 to 60 months 107 patients (34.2%) had stone recurrence. In group 1 the stone recurrence rate was 7.8%, which was significantly less (p <0.001) than in groups 2 (30%) and 3 (46.2%). Similarly new calculous events in patients with a history of multiple stone recurrence were less frequent in group 1 than in groups 2 and 3 (9.7, 47.4 and 52.2%, respectively, p <0.001). Multiple stone recurrence history, hypercalciuria, hyperuricosuria and calcium oxalate dihydrate calculi were independent risk factors for stone recurrence.
  
  
  CONCLUSIONS
  Regular medical prophylaxis may effectively prevent stone recurrence regardless of previous treatment modalities, stone composition, metabolic abnormalities and stone-free status. Cost effectiveness, patient compliance and gastrointestinal upset may limit patient acceptability and clinical use of medical prophylaxis. However, patients with a history of multiple stone recurrence, calcium oxalate dihydrate stones, hypercalciuria and hyperuricosuria benefit from regular medical prophylaxis.
authors: Department of Surgery, Veterans General Hospital-Kaohsiung, Taiwan, Republic of China.
authors: Y H
authors: YH
authors: Lee
authors: W C
authors: WC
authors: Huang
authors: J Y
authors: JY
authors: Tsai
authors: J K
authors: JK
authors: Huang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007669:Kidney Calculi / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D009566:Nitrates / Q000627:therapeutic use*; D017680:Potassium Compounds / Q000627:therapeutic use*; D012008:Recurrence; D012189:Retrospective Studies; D013997:Time Factors; D014514:Ureteral Calculi / Q000517:prevention & control*
chemical_list: D009566:Nitrates; D017680:Potassium Compounds; C023844:potassium nitrate