Stone symptoms and urinary deposits.
There is a general belief among the public and clinicians that urinary stone problem is always associated with symptoms like pain, dysuria and haematuria. Many patients stop medical treatment when they are symptom free and return with excruciating pain, dysuria and haematuria either alone or in combination. The objective of this study was to determine stone activity in an individual patient by assessing the urinary deposits at the time of the visit to the stone clinic and correlate with the presence or absence of symptoms at that time. 418 patients who attended the stone clinic in 2007 with proved urinary stone disease, including stone, colic and crystalluria, were studied. Presence or absence of symptoms at the time of presentation was recorded. Minimum of two samples of urine was collected (early morning and random) to assess the presence and extent (1-5) of urinary deposits namely red blood cells (RBC), pus cells (PC), calcium oxalate monohydrate (COM), calcium oxalate dihydrate (COD), uric acid and phosphate. The scores obtained were correlated with the presence or absence of symptoms by logistic regression. Of the 418 patients studied, 238 had symptoms and 180 had no symptoms. The total score of the deposits of patients with symptoms was 1,215 with a mean of 3.39 per patient against the score of 350 in the patients without symptoms with a mean of 2.99. This difference was not statistically significant. The total values and mean scores of the urinary deposits of all patients grouped together were RBC 561 (3.51), PC 434 (3.29), COM 177 (3.34), COD 237 (3.25), phosphate 113 (3.23) and uric acid 43 (1.95). Comparison of the total values and mean scores of the deposits of the patients with and without symptoms showed the variations as RBC 428 (3.51) versus 133 (3.5) PC 341 (3.38) versus 93 (3.0), COM 143 (3.25) versus 34 (3.78), COD 190 (3.88) versus 47 (1.96), phosphate 76 (3.3) versus 37 (3.1) and uric acid/ammonium urate 37 (1.95) versus 6 (2.0). Of these, the RBC, PC, uric acid and phosphates were not significantly different between the two groups. However, the presence of COD was significantly more in patients with symptoms (P < 0.05) and COM was significantly more in patients without symptoms (P < 0.05). It is concluded that the presence or absence of symptoms does not alter the presence and extent of urinary deposits significantly in the urinary stone patients. COD was more in symptomatic patients and COM was more in the asymptomatic patients. This contrast could be due to the morphology of the COD crystal which is dipyramidal and produces injury to urolthelium whereas COM is dumbbell shaped and produces lesser injury and lesser symptoms.
Fazil Marickar
Y M
YM
Department of Surgery, Zensa Hospital, Trivandrum, 695009, India. fazilmarickar@hotmail.com
Salim
Abiya
A
Vijay
Adarsh
A
D006801:Humans; D014545:Urinary Calculi / Q000175:diagnosis* / Q000652:urine*