Medical Treatment for Uric Acid Calculi

Kim, Young Ho; Lee, Nam Kyu; Park, Young Ho

Abstract

While surgical intervention may occasionally be indicated for the relief of pain or urinary obstruction, many uric acid stones can be treated medically. We have analysed 27 patients with uric acid stone treated at Soonchunhyang University Hospital from January 1991 to September 1994. Major clinical complaints were presented with flank pain(93%) and gross hematuria(33%). On the urinalysis, urinary pH was 5.0 in 21 patients(78%) , 5.5 in 4 patients(15%), and 6.0 in 2 patients(7%). The urate crystals were found in 11/27 patients(41%). Mean serum uric acid level was 6.5+/-3.2mg% and mean uric acid amount of 24hrs urine was 301+/-188mg. Intravenous urography, retrograde urography, antegrade urography, ultrasonography and computed tomography were used for the diagnosis of uric acid stone. Systemic medical therapy was performed in all patients using hydration, sodium bicarbonate, and allopurinol. Systemic medical therapy and local chemolysis with alkaline irrigating solution were performed in 6 patients(22%) when the stone size was large (.>2cm) or urinary obstruction existed. The uric acid stone, in whom treated with only systemic medical therapy(21), were to be dissolved and passed during 1-24weeks, whereas the other patients(6) with systemic medical therapy and local chemolysis due to complete obstruction or large stone( >=2cm) had taken 2-32weeks. Successful dissolution was obtained in all patients, however, most significant problem of uric acid stone chemolysis is that it takes a long time. Nevertheless, these results demonstrate that the medical treatment could ordinally be considered to the treatment of choice for removal of uric acid calculi before surgical intervention or extracorporeal shock wave lithotripsy.