title: Renal struvite stones--pathogenesis, microbiology, and management strategies.
abstract: Infection stones-which account for 10-15% of all urinary calculi-are thought to form in the presence of urease-producing bacteria. These calculi can cause significant morbidity and mortality if left untreated or treated inadequately; optimal treatment involves complete stone eradication in conjunction with antibiotic therapy. The three key principles of treating struvite stones are: removal of all stone fragments, the use of antibiotics to treat the infection, and prevention of recurrence. Several methods to remove stone fragments have been described in the literature, including the use of urease inhibitors, acidification therapy, dissolution therapy, extracorporeal shockwave lithotripsy, ureteroscopy, percutaneous nephrolithotomy (PCNL), and anatrophic nephrolithotomy. PCNL is considered to be the gold-standard approach to treating struvite calculi, but adjuncts might be used when deemed necessary. When selecting antibiotics to treat infection, it is necessary to acquire a stone culture or, at the very least, urine culture from the renal pelvis at time of surgery, as midstream urine cultures do not always reflect the causative organism.
authors.affiliation: The Stone Centre at Vancouver General Hospital, Jack Bell Research Centre, 2660 Oak Street, Vancouver, BC V6H 3Z6, Canada.
authors.forename: Ryan
authors.initials: R
authors.lastname: Flannigan
authors.affiliation: The Stone Centre at Vancouver General Hospital, Jack Bell Research Centre, 2660 Oak Street, Vancouver, BC V6H 3Z6, Canada.
authors.forename: Wai Ho
authors.initials: WH
authors.lastname: Choy
authors.affiliation: The Stone Centre at Vancouver General Hospital, Jack Bell Research Centre, 2660 Oak Street, Vancouver, BC V6H 3Z6, Canada.
authors.forename: Ben
authors.initials: B
authors.lastname: Chew
authors.affiliation: The Stone Centre at Vancouver General Hospital, Jack Bell Research Centre, 2660 Oak Street, Vancouver, BC V6H 3Z6, Canada.
authors.forename: Dirk
authors.initials: D
authors.lastname: Lange
mesh_terms: D000465:Algorithms; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003460:Crystallization; D004359:Drug Therapy, Combination; D006490:Hemostatics / Q000737:chemistry; D006801:Humans; D007669:Kidney Calculi / Q000737:chemistry / Q000175:diagnosis / Q000209:etiology / Q000382:microbiology / Q000628:therapy; D008096:Lithotripsy; D017616:Magnesium Compounds / Q000737:chemistry; D009403:Nephrostomy, Percutaneous / Q000379:methods; D010710:Phosphates / Q000737:chemistry; D000069877:Struvite; D016896:Treatment Outcome; D014510:Urease / Q000037:antagonists & inhibitors; D018666:Ureteroscopy; D014552:Urinary Tract Infections / Q000150:complications*
chemical_list: D000900:Anti-Bacterial Agents; D006490:Hemostatics; D017616:Magnesium Compounds; D010710:Phosphates; D000069877:Struvite; D014510:Urease