title: Composition and clinically determined hardness of urinary tract stones.
abstract: OBJECTIVE
  To derive hardness factors for crystal phases of urinary tract stones and describe the hardness pattern in a stone population.
  
  
  METHODS
  In a retrospective study, recordings from patients treated with extracorporeal shock-wave lithotripsy (ESWL) (stone surface area < or = 100 mm2) were used to derive hardness factors. The number of re-treatments, the number of shock waves and the energy index (the voltage in kilovolts multiplied by the number of shock waves) required for a satisfactory stone disintegration were assumed to reflect the hardness. The stone composition in 2100 patients provided the basis for an average hardness pattern. A hardness index was calculated from the fraction of each crystal phase and its hardness factor.
  
  
  RESULTS
  The hardness factors were as follows: calcium oxalate monohydrate, 1.3; calcium oxalate dehydrate, 1.0; hydroxyapatite, 1.1; brushite, 2.2; uric acid/urate, 1.0; cystine, 2.4; carbonate apatite, 1.3; magnesium ammonium phosphate, 1.0; and mixed infection stones, 1.0. The hardness index for 114 stones (surface area 100-200 mm2) corresponded reasonably well to the ESWL treatment efforts. Calcium oxalate monohydrate, calcium oxalate dihydrate and hydroxyapatite were the most frequently encountered crystal phases in all 2100 stones. Only 21% of the stones were composed of only one crystal phase. There were two, three and more than three crystal phases in 26%, 38% and 15% of the stones, respectively. The hardness index calculated for 2100 stones ranged between 0.70 and 2.33, with a mean (SD) of 1.18 (0.15).
  
  
  CONCLUSIONS
  The hardness factors and hardness index derived in this study might be useful for describing the stone situation in individual patients and groups of patients and for comparison of various treatment strategies.
authors.affiliation: Renal Stone Unit, Department of Urology, Karolinska University Hospital at Huddinge, Stockholm, Sweden.
authors.forename: Ida
authors.initials: I
authors.lastname: Ringdén
authors.forename: Hans-Göran
authors.initials: HG
authors.lastname: Tiselius
mesh_terms: D001031:Apatites / Q000032:analysis; D002129:Calcium Oxalate / Q000032:analysis; D002130:Calcium Phosphates / Q000032:analysis; D003553:Cystine / Q000032:analysis; D017886:Durapatite / Q000032:analysis; D006244:Hardness; D006801:Humans; D008096:Lithotripsy; D017616:Magnesium Compounds / Q000032:analysis; D010710:Phosphates / Q000032:analysis; D012189:Retrospective Studies; D000069877:Struvite; D014527:Uric Acid / Q000032:analysis; D014545:Urinary Calculi / Q000737:chemistry*; D014552:Urinary Tract Infections / Q000150:complications
chemical_list: D001031:Apatites; D002130:Calcium Phosphates; D017616:Magnesium Compounds; D010710:Phosphates; D002129:Calcium Oxalate; D014527:Uric Acid; D003553:Cystine; C030782:carboapatite; D017886:Durapatite; D000069877:Struvite; C494366:calcium phosphate, dibasic, dihydrate