Papillary Ductal Plugging Is a Mechanism for Early Stone Retention in Brushite Stone Disease

dc.contributor.authorWilliams, James C., Jr.
dc.contributor.authorBorofsky, Michael S.
dc.contributor.authorBledsoe, Sharon B.
dc.contributor.authorEvan, Andrew P.
dc.contributor.authorCoe, Fredric L.
dc.contributor.authorWorcester, Elaine M.
dc.contributor.authorLingeman, James E.
dc.contributor.departmentDepartment of Urology, School of Medicineen_US
dc.date.accessioned2017-10-05T17:44:32Z
dc.date.available2017-10-05T17:44:32Z
dc.date.issued2017
dc.description.abstractPurpose Mechanisms of early stone retention in the kidney are under studied and poorly understood. To date attachment via Randall plaque is the only widely accepted theory in this regard, which is best described in idiopathic calcium oxalate stone formers. Brushite stone formers are known to have distinct papillary morphology relative to calcium oxalate stone formers. As such we sought to determine whether stone attachment mechanisms in such patients may be similarly unique. Materials and Methods Patients undergoing percutaneous and or ureteroscopic procedures for stone removal consented to endoscopic renal papillary examination and individual stone collection. Each removed stone was processed using micro computerized tomography to assess the 3-dimensional microstructure and the minerals contained, and search for common structural features indicative of novel mechanisms of early growth and attachment to renal tissue. Results A total of 25 intact brushite stones were removed from 8 patients and analyzed. Video confirmed attachment of 13 of the 25 stones with the remainder believed to have been accidently dislodged during the procedure. Microscopic examination by light and computerized tomography failed to show evidence of Randall plaque associated with any stone containing brushite. Conversely each brushite stone demonstrated microstructural evidence of having grown attached to a ductal plug formed of apatite. Conclusions Three-dimensional analysis of small brushite stones suggests overgrowth on ductal apatite plugs as a mechanism of early stone growth and retention. Such findings represent what is to our knowledge the initial supporting evidence for a novel mechanism of stone formation which has previously been hypothesized but never verified.en_US
dc.eprint.versionAuthor's manuscripten_US
dc.identifier.citationWilliams, J. C., Borofsky, M. S., Bledsoe, S. B., Evan, A. P., Coe, F. L., Worcester, E. M., & Lingeman, J. E. (2017). Papillary ductal plugging is a mechanism for early stone retention in brushite stone disease. The Journal of Urology. https://doi.org/10.1016/j.juro.2017.08.063en_US
dc.identifier.urihttps://hdl.handle.net/1805/14249
dc.language.isoenen_US
dc.publisherElsevieren_US
dc.relation.isversionof10.1016/j.juro.2017.08.063en_US
dc.relation.journalThe Journal of Urologyen_US
dc.rightsPublisher Policyen_US
dc.sourceAuthoren_US
dc.subjectkidney calculien_US
dc.subjectcalcium phosphateen_US
dc.subjectdibasicen_US
dc.titlePapillary Ductal Plugging Is a Mechanism for Early Stone Retention in Brushite Stone Diseaseen_US
dc.typeArticleen_US
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