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UROLITHIASIS: EPIDEMIOLOGY AND RISK FACTORS
Bahromov Bekzod Shavkatovich
Asian International University, Bukhara, Uzbekistan.
https://doi.org/10.5281/zenodo.15070401
Abstract.
Stone formation in the urinary tract affects about 7–12% of the population in
industrialized countries, although it is very rare in other countries such as Greenland or Japan.
The high incidence and recurrence rate contribute to making the urolithiasis a serious
social problem. Nowadays, urolithiasis must be considered a ‘disease in evolution’ for several
reasons, such as epidemiological changes, evolution of the methods used for diagnosis, and the
treatment and prophylaxis of the population considered ‘at risk’ of stone disease. Some features
of stone disease have changed over the last few years due to many social, economical and
cultural factors that are described here. The increased prevalence of small urinary calculi has
brought about a change in clinical symptoms, with frequent episodes of renal-ureteral colic,
persistent pain and hydronephrosis. Similarly, the presence of residual fragments after
extracorporeal shock wave lithotripsy has induced a radical change in the management of small
calculi through the use of mini-invasive surgical techniques.
Key Words:
Urinary stones, epidemiology Risk factors, urinary stones Extracorporeal
shock wave lithotripsy, residual fragments.
МОЧЕКАМЕННАЯ БОЛЕЗНЬ: ЭПИДЕМИОЛОГИЯ И ФАКТОРЫ РИСКА
Аннотация.
Образование камней в мочевыводящих путях затрагивает около 7–
12% населения в промышленно развитых странах, хотя это очень редкое явление в других
странах, таких как Гренландия или Япония. Высокая заболеваемость и частота
рецидивов способствуют тому, что мочекаменная болезнь становится серьезной
социальной проблемой. В настоящее время мочекаменная болезнь должна считаться
«болезнью в процессе эволюции» по нескольким причинам, таким как эпидемиологические
изменения, эволюция методов, используемых для диагностики, а также лечение и
профилактика населения, считающегося «группой риска» по мочекаменной болезни.
Некоторые особенности мочекаменной болезни изменились за последние несколько
лет из-за многих социальных, экономических и культурных факторов, которые описаны
здесь. Возросшая распространенность мелких мочевых камней привела к изменению
клинических симптомов с частыми эпизодами почечно-мочеточниковой колики,
постоянной болью и гидронефрозом. Аналогичным образом, наличие остаточных
фрагментов после экстракорпоральной ударно-волновой литотрипсии вызвало
радикальное изменение в лечении небольших камней с помощью мини-инвазивных
хирургических методов.
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Ключевые слова:
Мочевые камни, эпидемиология Факторы риска, мочевые камни
Экстракорпоральная ударно-волновая литотрипсия, остаточные фрагменты.
Introduction. Stone formation in the urinary tract affects about 8-13% of the population in
industrialized countries, although it is very rare in Greenland or in Japan. This could be for
various reasons, such as diet, climate, daily water intake, physical activity and corporeal
overweight. The annual incidence of stone formation is generally considered to be 1,500–2,000
cases per million.
Data on the incidence of stone disease in Italy derive from a national survey carried out
by the National Institutes of Statistics in 2000; the prevalence is 19.2% and a total social costs
amount to EUR 200 million/year. Urinary calculi are commonly diagnosed as a consequence of
an episode of renal-ureteral colic or gross hematuria. Many patients are diagnosed after an
abdominal ultrasound scan after reporting unrelated symptoms. On the other hand, stone disease
must be considered a ‘disease in evolution’ for several reasons, such as epidemiological changes,
advances in the methods used for diagnosis, treatment and prophylaxis of the population
considered ‘at risk’ of the disease.
Epidemiology The risk of developing urinary tract stone disease in normal adults varies
in different countries in the world. The probability of stone formation seems to be lower in Asia
(2–8%) than Europe (9–15%) and the USA (23%). The highest risk is reported in Saudi Arabia
(27%).
In recent years, the prevalence and incidence of urinary stones has increased. The
epidemiology of stone disease differs according to the geographical area and historical period.
Changing socioeconomic conditions have generated changes in the incidence and type of
stones in terms of both site and the physical-chemical composition of stones. Stone Components
the main chemical component of stones is calcium oxalate (60–78%), either in its pure form
(27%) or mixed with calcium phosphate (40%). Other types of urinary stones are uric acid (20–
25%), struvite (ammonium-magnesium phosphate, 5–10%) and cystine (3–4%). Rarer stones are
made of silica and xanthine and 2,8-dihydroxyadenine. Urinary calculi have changed in
composition over the last few years, due to an increased rate of calcium-oxalate (from 65 to
85%) in the urine, while infection-related stone formation has decreased sharply from 20 to 5%.
This could be due to both the higher quality of life in developed countries and the
widespread use of antibiotics. The epidemiology of cystine stones has not changed, because
homozygous cystinuria persists in a small proportion of the population. The prevalence of uric
acid stones has also dropped from 17 to 5% the reduction could be related to the early
identification of patients’ metabolic alterations and controlled dietary regimens in overweight
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patients. Stone Size In the last two decades, an increased rate of small ureteral stones has been
found. This phenomenon could be due to the widespread use of extracorporeal shock wave
lithotripsy (ESWL), with subsequent reclamation of large-sized renal calculi, and noninvasive
diagnostic techniques such as ultrasound and spiral computed to mography. The increased
prevalence of small urinary calculi (! 1 cm) has changed the clinical symptoms, with frequent
episodes of renal-ureteral colic, persistent pain and hydronephrosis, leading to a fundamental
change in disease management. Small calculi are often removed by means of mini-invasive
techniques such as uretero-litholapaxy or uretrorenoscopy with intra-ure teral calculi
fragmentation. ESWL can still be used as a first-step treatment option for distal ureteral or
medium-sized renal stones (between 0.5 and 2 cm), while percutaneous nephrolithotripsy should
be reserved for treating larger calculi. The modern urologist knows that the decrease could be
due to both a rational interpretation of urinary tract obstructive phenomena and a substantial
reduction in malnutrition throughout the world. Risk Factors Stone disease presents a complex
model for interpreting the mechanisms involved in its genesis and development, as well as
genetic, anatomic, nutritional, and environmental factors together with the presence of
concomitant diseases.
Moreover, much evidence has recently been provided on dietary factors, such as animal
protein consumption and daily caloric intake, related to an increased risk of stone formation.
Age, Race and Sex The prevalence of urinary stones varies according to age. In subjects
under 45 years old the prevalence is 0.6%, while in those over 65 it is 7%. This correlation is
probably due to the presence of comorbidities (obesity, hypertension, hyperuricemia, etc.). In
Central Asia, the male-female ratio is 2: 1, according to the probability of stone formation.
About 30% of the patients with urinary stones have a family history of stone disease,
showing that it may be the result of a polygenic defect with partial penetrance. In addition, it has
been clearly demonstrated that familial renal tubular acidosis is strong associated with
nephrolithiasis in almost 80% of patients. The fact that men have a higher incidence than females
is probably related to sex hormones.
Climate and Seasons:
Stone recurrence is higher in spring and summer than in autumn
and winter, probably due to low fluid intake and low urinary output. Another possible
explanation is high vitamin D plasma levels due to longer sun exposure time. The effect of
geography on the incidence and prevalence of stone diseases may be indirectly due to its effect
on temperature. High temperatures increase perspiration insensibility which may result in more
concentrated urine. This event promotes urinary crystallization and stone formation. Dietary
Habits Nutritional risk factors have recently been described: increased animal protein, calcium
and oxalate intake as well as a high calorie content in the diet.
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The correlation between calcium intake and stone formation risk still needs to be
demonstrated. A significant relationship between div mass index and increased risk of stone
formation. Other authors reported an inverse correlation between div mass index and patients’
urinary pH. In a recent randomized study, Borghi et al. confirmed the main value of a generous
fluid in take.
Conclusion:
Urinary stone disease is a severe problem in Central Asia with high
prevalence and incidence rates. There are strong links between the socioeconomic status of the
individuals and the causal factors of stone formation, since the socioeconomic status mostly
affects the dietary habits and the chances of having appropriate health care. Geographic
variations in the distribution of stone disease might enlighten the roles of climate and soil proper
ties but this is only to be achieved by more extensive studies.
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