UROLITHIASIS: EPIDEMIOLOGY AND RISK FACTORS

Аннотация

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. 1114 ResearchBib IF - 11.01, ISSN: 3030-3753, Volume 2 Issue 3 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 wi