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Background <p>Urolithiasis has a 50% 5-year recurrence rate. Post-operative changes in urinary relative supersaturation (RSS) may refine recurrence prediction and guide targeted interventions.</p> Methods <p>Prospective cohort of 68 stone-free adults (Jan 2023 – Jan 2024 enrollment). 24-hour urine was collected at 2 weeks, 1, 3, 6, 12 months; RSS patterns were analyzed using multivariate modeling. We used a validated food frequency questionnaire adapted for stone-forming nutrients. Primary outcome: radiologic and symptomatic stone recurrence; secondary: ≥30% RSS reduction (“biochemical response”). Risk scoring system developed using logistic regression probabilities. The study was approved by the institutional ethics committee with written informed consent.</p> Results <p>At 24-month median follow-up (range 18–30), 14/68 experienced recurrence (20.6%). Independent predictors: persistently-high CaOx-RSS (OR 6.84, 95% CI 2.13–21.97), CaP-RSS &gt; 1.5 on ≥ 2 visits (OR 4.38, 1.29–14.85), pH-reactive UA-RSS (OR 3.25, 1.04–10.18), urine volume &lt; 1.5&#xa0;L (OR 3.12, 1.21–8.03). Model performance: AUC 0.81 (95% CI 0.72–0.90); optimal threshold (<i>p</i> = 0.22) yielded sensitivity 0.74, specificity 0.78, PPV 0.46, NPV 0.92. RSS-guided intervention reduced recurrence versus standard care (11.8% vs. 29.4%, <i>p</i> = 0.027) with 44.5% absolute risk reduction in high-risk patients.</p> Conclusions <p>Serial RSS patterns combined with clinical variables predict recurrence with good accuracy. RSS-tailored therapy significantly reduces recurrence in high-risk patients, though implementation requires addressing feasibility and cost-effectiveness considerations.</p>

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Study on changes in urinary relative supersaturation and risk of stone recurrence in patients after urolithiasis surgery

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年10月17日

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  • Kaisaier Aji,
  • Munila Maimaijiang,
  • Guanglu Song

摘要

Background

Urolithiasis has a 50% 5-year recurrence rate. Post-operative changes in urinary relative supersaturation (RSS) may refine recurrence prediction and guide targeted interventions.

Methods

Prospective cohort of 68 stone-free adults (Jan 2023 – Jan 2024 enrollment). 24-hour urine was collected at 2 weeks, 1, 3, 6, 12 months; RSS patterns were analyzed using multivariate modeling. We used a validated food frequency questionnaire adapted for stone-forming nutrients. Primary outcome: radiologic and symptomatic stone recurrence; secondary: ≥30% RSS reduction (“biochemical response”). Risk scoring system developed using logistic regression probabilities. The study was approved by the institutional ethics committee with written informed consent.

Results

At 24-month median follow-up (range 18–30), 14/68 experienced recurrence (20.6%). Independent predictors: persistently-high CaOx-RSS (OR 6.84, 95% CI 2.13–21.97), CaP-RSS > 1.5 on ≥ 2 visits (OR 4.38, 1.29–14.85), pH-reactive UA-RSS (OR 3.25, 1.04–10.18), urine volume < 1.5 L (OR 3.12, 1.21–8.03). Model performance: AUC 0.81 (95% CI 0.72–0.90); optimal threshold (p = 0.22) yielded sensitivity 0.74, specificity 0.78, PPV 0.46, NPV 0.92. RSS-guided intervention reduced recurrence versus standard care (11.8% vs. 29.4%, p = 0.027) with 44.5% absolute risk reduction in high-risk patients.

Conclusions

Serial RSS patterns combined with clinical variables predict recurrence with good accuracy. RSS-tailored therapy significantly reduces recurrence in high-risk patients, though implementation requires addressing feasibility and cost-effectiveness considerations.