MP26-16 KNOWING A STONE’s COMPOSITION IS ASSOCIATED WITH INCREASED MEDICAL DIRECTED THERAPY

You have accessJournal of UrologyStone Disease: Medical & Dietary Therapy (MP26)1 May 2024MP26-16 KNOWING A STONE's COMPOSITION IS ASSOCIATED WITH INCREASED MEDICAL DIRECTED THERAPY Wilson Sui, Kevin Chang, Jorge Mena, Heiko Yang, Ashwin Balakrishnan, Maria C. Velasquez, Marshall Stoller, and Thomas Chi Wilson SuiWilson Sui , Kevin ChangKevin Chang , Jorge MenaJorge Mena , Heiko YangHeiko Yang , Ashwin BalakrishnanAshwin Balakrishnan , Maria C. VelasquezMaria C. Velasquez , Marshall StollerMarshall Stoller , and Thomas ChiThomas Chi View All Author Informationhttps://doi.org/10.1097/01.JU.0001009408.66023.77.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: While stone composition analysis is suggested by the American Urologic Association (AUA) guidelines, the popularity of "dusting" techniques during ureteroscopy have limited opportunities to send specimen for this notoriously inconsistent test. When a 24-hour study has been completed, the additional information gleaned from a stone composition is unclear. Rates of directed medical therapy are low even at tertiary care centers. The goal of this study was to identify whether the presence of stone composition impacted initiation of directed medical therapy. METHODS: Our institutional kidney stone database was queried for all patients who underwent 24-hour urine studies from 2016-23. Only patients with calcium and uric acid stones were included. Hypercalciuria, hypocitraturia and low pH were defined by reference ranges. Severe hypercalciuria was defined as ≥350mg/day for men and≥300 for women and severe hypocitraturia was≤289 and≤320 respectively. These extreme cases represented the top quartile of participants. Rates of initiation of directed medical therapy were compared amongst those with and without available stone composition using chi-square analysis and logistic regression. RESULTS: Stone composition was available in 40 % of the 723 patients were identified. Among those with severely abnormal values, 50% with known calcium stones were initiated on thiazide compared to only 11% of those without stone composition (Figure 1, p=0.002). For those with pH<5.5 and uric acid stones, 43% were initiated on alkali if stone composition was available compared to 25% if not (p=0.174). In patients with hypocitraturia, stone composition was not associated with alkali therapy. On multivariable logistic regression, stone composition was a predictor for initiation of thiazides (OR 2.4, 95% CI 1.1 - 4.9) for patients with hypercalciuria and akali (OR 1.7, 95% CI 1.1 - 2.6) in low pH. CONCLUSIONS: While many patients were initiated on directed medical therapy based on the 24-hour urine abnormality, the rate of medication initiation increased when stone composition was available. Reasons for this finding include patient receptiveness to therapy or providers are more proactive in guiding patients towards directed therapy. Additional research should investigate barriers to initiating medical therapy given the low rates of utilization. Download PPT Source of Funding: N/A © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e420 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Wilson Sui More articles by this author Kevin Chang More articles by this author Jorge Mena More articles by this author Heiko Yang More articles by this author Ashwin Balakrishnan More articles by this author Maria C. Velasquez More articles by this author Marshall Stoller More articles by this author Thomas Chi More articles by this author Expand All Advertisement PDF downloadLoading ...