24 – Hour Urine Analysis: Is Much Gained?
BAUS ePoster online library. Raja K. 06/21/21; 319101; p6-3
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Mr. Kishore Raja
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Abstract
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Introduction
Metabolic work up of recurrent stone formers has traditionally included a 24-hour urinalysis (24HU) along with blood biochemistry and stone analysis. Being a laborious test with suboptimal patient compliance and significant cost implications, 24HU has divided opinion among Urologists. Recent NICE guidelines have not included 24HU in essential steps of metabolic stone work-up quoting lack of strong evidence.
Patients and methods
A retrospective analysis of 745 patients who had their urinary calculi analysed in our institution during the time period of January 2013 to November 2018 checking if a 24HU added any extra information resulting in actual change in patient management than what stone analysis report alone could provide along with serum biochemistry.
Results
Metabolic work-up with 24HU had been performed only on 192 patients (40.42%), their mean age was 50.01±14.51 years and 71 were women. Average urine volume collected was 2158.68 mls. Of the stones analysed, 108 (56.54%) were CaOx, 61 (31.94%) CaPO4, 21 (10.99%) uric acid and 1 struvite. All 12 hyperthyroid patients had calcium stones, 7 of them had hypercalciuria and 5 had hypercalcemia. Sub-analysis of 24HU values based on their stone analysis showed higher total calcium and total urate values in calcium and uric acid stone formers respectively as expected but total oxalate values were higher in uric acid stone formers. Only 41% of CaOx stone formers and 28% of CaPO4 stone formers showed hypercalciuria.
Conclusion
24HU adds critical information that stone analysis and serum biochemistry by themselves can't provide in managing recurrent stone formers.
Metabolic work up of recurrent stone formers has traditionally included a 24-hour urinalysis (24HU) along with blood biochemistry and stone analysis. Being a laborious test with suboptimal patient compliance and significant cost implications, 24HU has divided opinion among Urologists. Recent NICE guidelines have not included 24HU in essential steps of metabolic stone work-up quoting lack of strong evidence.
Patients and methods
A retrospective analysis of 745 patients who had their urinary calculi analysed in our institution during the time period of January 2013 to November 2018 checking if a 24HU added any extra information resulting in actual change in patient management than what stone analysis report alone could provide along with serum biochemistry.
Results
Metabolic work-up with 24HU had been performed only on 192 patients (40.42%), their mean age was 50.01±14.51 years and 71 were women. Average urine volume collected was 2158.68 mls. Of the stones analysed, 108 (56.54%) were CaOx, 61 (31.94%) CaPO4, 21 (10.99%) uric acid and 1 struvite. All 12 hyperthyroid patients had calcium stones, 7 of them had hypercalciuria and 5 had hypercalcemia. Sub-analysis of 24HU values based on their stone analysis showed higher total calcium and total urate values in calcium and uric acid stone formers respectively as expected but total oxalate values were higher in uric acid stone formers. Only 41% of CaOx stone formers and 28% of CaPO4 stone formers showed hypercalciuria.
Conclusion
24HU adds critical information that stone analysis and serum biochemistry by themselves can't provide in managing recurrent stone formers.
Introduction
Metabolic work up of recurrent stone formers has traditionally included a 24-hour urinalysis (24HU) along with blood biochemistry and stone analysis. Being a laborious test with suboptimal patient compliance and significant cost implications, 24HU has divided opinion among Urologists. Recent NICE guidelines have not included 24HU in essential steps of metabolic stone work-up quoting lack of strong evidence.
Patients and methods
A retrospective analysis of 745 patients who had their urinary calculi analysed in our institution during the time period of January 2013 to November 2018 checking if a 24HU added any extra information resulting in actual change in patient management than what stone analysis report alone could provide along with serum biochemistry.
Results
Metabolic work-up with 24HU had been performed only on 192 patients (40.42%), their mean age was 50.01±14.51 years and 71 were women. Average urine volume collected was 2158.68 mls. Of the stones analysed, 108 (56.54%) were CaOx, 61 (31.94%) CaPO4, 21 (10.99%) uric acid and 1 struvite. All 12 hyperthyroid patients had calcium stones, 7 of them had hypercalciuria and 5 had hypercalcemia. Sub-analysis of 24HU values based on their stone analysis showed higher total calcium and total urate values in calcium and uric acid stone formers respectively as expected but total oxalate values were higher in uric acid stone formers. Only 41% of CaOx stone formers and 28% of CaPO4 stone formers showed hypercalciuria.
Conclusion
24HU adds critical information that stone analysis and serum biochemistry by themselves can't provide in managing recurrent stone formers.
Metabolic work up of recurrent stone formers has traditionally included a 24-hour urinalysis (24HU) along with blood biochemistry and stone analysis. Being a laborious test with suboptimal patient compliance and significant cost implications, 24HU has divided opinion among Urologists. Recent NICE guidelines have not included 24HU in essential steps of metabolic stone work-up quoting lack of strong evidence.
Patients and methods
A retrospective analysis of 745 patients who had their urinary calculi analysed in our institution during the time period of January 2013 to November 2018 checking if a 24HU added any extra information resulting in actual change in patient management than what stone analysis report alone could provide along with serum biochemistry.
Results
Metabolic work-up with 24HU had been performed only on 192 patients (40.42%), their mean age was 50.01±14.51 years and 71 were women. Average urine volume collected was 2158.68 mls. Of the stones analysed, 108 (56.54%) were CaOx, 61 (31.94%) CaPO4, 21 (10.99%) uric acid and 1 struvite. All 12 hyperthyroid patients had calcium stones, 7 of them had hypercalciuria and 5 had hypercalcemia. Sub-analysis of 24HU values based on their stone analysis showed higher total calcium and total urate values in calcium and uric acid stone formers respectively as expected but total oxalate values were higher in uric acid stone formers. Only 41% of CaOx stone formers and 28% of CaPO4 stone formers showed hypercalciuria.
Conclusion
24HU adds critical information that stone analysis and serum biochemistry by themselves can't provide in managing recurrent stone formers.
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