Logo image
Back
IP18-28 THE USE AND EFFECT OF STONE PROPHYLACTIC MEDICATIONS ON 24-HOUR URINE CHEMISTRY PARAMETERS IN BRUSHITE STONE FORMERS
Abstract   Peer reviewed

IP18-28 THE USE AND EFFECT OF STONE PROPHYLACTIC MEDICATIONS ON 24-HOUR URINE CHEMISTRY PARAMETERS IN BRUSHITE STONE FORMERS

Kyle Berst, Cheney Hurley, Timothy Chow, Melissa Swee, Chad Tracy and Ryan Steinberg
The Journal of urology, Vol.215(5S), p.e376
05/2026
DOI: 10.1097/01.JU.0001191368.71794.72.28

View Online

Abstract

INTRODUCTION AND OBJECTIVES: Brushite (calcium monohydrogen phosphate) stone formers are notoriously difficult to manage with high rate of urine chemistry abnormalities. Medical therapy has been shown to be effective in improving 24-hour urine chemistry parameters amongst calcium stone formers in general but not specifically amongst brushite stone formers. We sought to assess medical use and the effect of medical therapy amongst this population. METHODS: We conducted a retrospective, IRB-approved, single-institution review of all patients with any amount of brushite on stone analysis from January 2014 to June 2024. Patient demographics, medical histories, procedures, lab results, medications, and 24-hour urine chemistries were collected. Medications were converted into equivalents (mg of HCTZ for diuretics, mEq for alkaline) and the total daily dose. Descriptive statistics were generated. A Wilcoxon signed-rank test compared the baseline and treatment urine parameters. RESULTS: We identified 119 brushite stone formers (40% male) with a median age of 37 years (IQR 27-53) and median follow-up of 3.9 years (IQR 0.7-8.5). 9 (8%) patients were on medical therapy at the initial visit and 57 (48%) were started on medication during care. 34 (52%) patients were treated with monotherapy and 32 (48%) with combination therapy. 51 (43%) were treated with diuretics, of which 21 (41%) discontinued therapy. 43 (36%) were treated with alkali, of which 16 (37%) discontinued therapy. Alkali therapy showed only a significant change in urine pH with moderate dosing but clinically meaningful differences in citrate and pH were noted at doses >=40 mEq. A statistically significant but clinically insignificant decrease in urine calcium was observed with low dose diuretics. CONCLUSIONS: Brushite stone formers have high rates of medical therapy discontinuation. Alkali supplementation confers clinically meaningful changes to urine parameters but the same was not seen for diuretics. When using medical therapy, at least moderate dosing levels appear to be needed to confer the desired change. This study was limited by the small cohorts and further evaluation in larger cohorts is needed.

Details

Metrics

1 Record Views
Logo image