Dissolution of Radiolucent Renal Stones by Oral Alkalinization Therapy with Potassium Citrate is Effective Even in Staghorn Stones

الملخص

Background: Urolithiasis is a widespread problem that affects up to 10% of the population. Uric acid stones represent around 10% of urolithiasis (second to calcium stones in prevalence). Urine alkalinization therapy is a recognized treatment for dissolving radiolucent renal stones, particularly uric acid stones. Potassium citrate is currently the treatment of choice for urine alkalization with minimal side effects and high tolerability. This treatment works by increasing urine pH, creating an environment that inhibits stone growth and promotes dissolution. Its efficacy in managing staghorn stones is less established. This study evaluates the effectiveness of potassium citrate in dissolving radiolucent renal stones, including staghorn stones. 11 patients with radiolucent stones were included in this prospective study, which was conducted from January 2012 to December 2016 at the National Cancer Institute-Misurata in Libya. KUB x-ray used to exclude radio-opaque stones. All patients treated with oral potassium citrate in different doses according to urine pH were followed for 1-10 months by USS and NCCT scan at the end of treatment. Of all 11 patients, the mean stone size was 2.5mm. The mean stone attenuation value (HU) was 247.4. Complete dissolution of the stone was achieved, and no surgical intervention was required. Treatment time for successful dissolution varied, with an average of 3 months minimum and 9 months maximum.  All DJ stents & nephrostomy tubes were removed after complete dissolution of the stones. Tolerance of the drug was good, and no side effects were observed. Urinary alkalization with potassium citrate is a safe, effective, and well-tolerated treatment in radiolucent stones, even stag horn stones, which can save the patients from unnecessary intervention.