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2016 ; 5
(ä): 2651
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Recent advances in understanding and managing urolithiasis
#MMPMID27853528
Strohmaier WL
F1000Res
2016[]; 5
(ä): 2651
PMID27853528
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During the last few years, there has been relevant progress in both understanding
and managing urolithiasis. Our knowledge of stone formation has changed; although
the importance of urine biochemistry was questioned by several investigators
years ago, the decisive role of cellular processes (induced by oxidative stress)
and the renal papilla has only recently been generally accepted as the most
important step in stone formation. For calcium oxalate urolithiasis, the
formation of papillary calcifications plays a key role and is of prognostic
relevance. Further research has to concentrate on these aspects of preventing
urolithiasis. Stone prevention (metaphylaxis) is a major issue when considering
the burden it places on healthcare systems. An effective metaphylaxis could lower
the cost of stone therapy significantly. For uric acid urolithiasis, so far there
is only preliminary information available showing that papillary plaques are not
as important as they are in calcium oxalate urolithiasis. Concerning stone
management, endourology has improved stone therapy significantly during the last
few years. Morbidity decreased and success (stone-free) rates increased.
Therefore, the indications for extracorporeal shockwave lithotripsy (ESWL)
narrowed. ESWL, however, still has its place in stone therapy. There is not one
single treatment modality that is equally effective for all situations. It is
important to observe the differential indications for different stones depending
on size, localization, and composition.