Mp58-02 Novel Insight Into Stone Formation Mechanisms Using Micro Ct: Verification That Randall’s Plaques and Ductal Plugs Can Produce Clinically Significant Stones
Year: 2016
Type: article
Abstract: You have accessJournal of UrologyStone Disease: Basic Research & Pathophysiology I1 Apr 2016MP58-02 NOVEL INSIGHT INTO STONE FORMATION MECHANISMS USING MICRO CT: VERIFICATION THAT RANDALL’S PLAQUES AND DUCTAL PLUGS CAN PRODUCE CLINICALLY SIGNIFICANT STONES James C. Williams, Michael S. Borofsky, Andrew P. Evan, Fredric Coe, Elaine Worcester, and James E. Lingeman James C. WilliamsJames C. Williams More articles by this author , Michael S. BorofskyMichael S. Borofsky More articles by this author , Andrew P. EvanAndrew P. Evan More articles by this author , Fredric CoeFredric Coe More articles by this author , Elaine WorcesterElaine Worcester More articles by this author , and James E. LingemanJames E. Lingeman More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.800AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES There are two pathologies described by which stones can be retained within the renal calyx during early growth: attachment to Randall's plaques (RP), and growth onto ductal mineral plugs (DP). The significance of these nascent pathologies remains unclear, particularly their potential to directly produce stones of a clinically significant size. METHODS Stones were collected from patients undergoing ureteroscopic or percutaneous stone removal, and each stone was subjected to micro CT imaging (Skyscan 1172) with a final voxel size of 2-7 μm. Stones were identified (blindly) as having grown on RP or DP. Stones that could not be confidently identified as RP or DP were not included. RESULTS 34 patients had at least one stone classed as having grown on RP or DP, with an average of 6.7 per patient (range 1-40 stones), with 189 stones classed as growing on RP and 33 stones growing on DP. RP regions were all composed of apatite, were on average 338±212 μm wide and 308±180 μm long (i.e., depth of interstitium pulled out with the stone), and showed luminal spaces (from tubules or capillaries trapped in the plaque) in 86% of the cases. The calyceal mineral growing on the RP was composed exclusively of either calcium oxalate (CaOx, 61%) or CaOx mixed with apatite (39%). DP regions on stones were all cylindrical in shape and composed of apatite: 555±342 μm wide and 1167±848 μm long, both larger than RP (P<0.0011). Mineral growing on DP was composed of CaOx (33%), CaOx with apatite (30%), or mixtures including brushite (36%). Overall size of stones on DP was 2.7±1.7 vs. 2.1±1.2 mm for RP, P=0.025. Overall, 11% of the stones were ≥ 4 mm in size (not different between RP and DP). CONCLUSIONS Stones found growing on RP can be easily identified using micro CT, with 86% of the cases showing lumens of interstitial structures, confirming their identity as RP. Stones found growing on apparent plugs of mineral from collecting duct lumens were morphologically distinct from RP attachment sites, and it was only on these that brushite was found. The overall sizes of the nascent stones found in this study averaged 2.2 mm, and 11% of the stones were ≥4 mm in size. Thus, stones of significant size can grow on both RP and DP, showing that these two mechanisms of early stone retention can result in clinically relevant stones. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e775-e776 Advertisement Copyright & Permissions© 2016MetricsAuthor Information James C. Williams More articles by this author Michael S. Borofsky More articles by this author Andrew P. Evan More articles by this author Fredric Coe More articles by this author Elaine Worcester More articles by this author James E. Lingeman More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...
Source: The Journal of Urology
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2327779916