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RECURRENCE FOLLOWING OPERATIONS FOR UPPER URINARY TRACT STONE 1
Author(s) -
Sutherland James W.
Publication year - 1954
Publication title -
british journal of urology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 0007-1331
DOI - 10.1111/j.1464-410x.1954.tb04732.x
Subject(s) - medicine , incidence (geometry) , surgery , nephrectomy , upper urinary tract , urinary system , kidney , physics , optics
SUMMARY1 The incidence of recurrence following operative treatment of upper urinary tract stone has been investigated in 216 out of 345 patients subjected to operation during the years 1915 to 1950. These patients all attended for interview followed by X‐ray and urine examination. No case is included in which operation took place less than two years ago. 2 Possible ætiological factors are detailed, as well as the side, sex, and age incidence for the entire series of 345 cases. There is evidence of an earlier onset of lithiasis in males. 3 Recurrence has been graded as “mild” and “severe,” depending on whether or not secondary operation has been necessary. “False” recurrences, i.e. , stones overlooked at operation, are included, but their incidence is not accurately known. Recurrence figures for the various types of operation are:–Pyelolithotomy (100 cases): Mild recurrence, 20 per cent.; severe recurrence, 27 per cent. Nephrolithotomy (forty cases): Mild recurrence, 25 per cent.; severe recurrence, 37.5 per cent. Ureterolithotomy (forty‐nine cases): Mild recurrence, 29 per cent.; severe recurrence, 8 per cent. Ureteric meatotomy (six cases): Mild recurrence, 17 per cent. Nephrectomy (forty‐five cases): Contralateral recurrence, 11.1 per cent. The total recurrence following 240 operations of all types (including nephrectomy) is 40 per cent. Following 195 conservative operations the recurrence rate is 46.7 per cent.4 Less than half the recurrences actively sought advice for relief of symptoms and would have been missed by questionnaire follow‐up. 5 Reasons are presented for the high recurrence rate, the principal factor being the strict standards observed in the investigation. 6 Comparison of recurrence in the decades 1930 to 1940 and 1940 to 1950 shows a reduction of 11 per cent. in the latter, from 47 to 36 per cent. 7 Recurrence is twice as common in males (54.3 per cent.) as in females (21.8 per cent.). 8 Contralateral recurrence is almost as common after nephrectomy (11.1 per cent.) as after conservative operations (12.3 per cent.). 9 Of the eighty‐nine recurrent cases twenty‐five (28 per cent.) were detected within two years, fifty‐two (58.4 per cent.) within five years, and seventy‐eight (87.6 per cent.) within ten years of operation. 10 Whether the stones were single or multiple seems to bear no constant relationship to the incidence of recurrence. 11 Urinary infection and recurrence are closely related. Of those patients with sterile urine before operation only 13 per cent. had a recurrence compared with 64.5 per cent, of those with infected urine. In this series B. coli was the commonest organism, and the urea‐splitting organisms did not appear to be as important as usual. 12 The incidence of hyperparathyroidism is low (2.7 per cent.). 13 The management of recurrent cases is discussed and measures are suggested for avoiding recurrence. Conservatism in this field appears to be completely justified and an increasingly important place has been found for partial nephrectomy. 14 Regular follow‐up of these cases is essential. 15 The various operations for upper urinary tract stone treat the effect not the cause. Recurrence may be lessened by the various measures mentioned but will continue until more is known of the underlying ætiology.