The prevalence of uric acid (UA) urolithiasis contributes significantly to global disease burden, due to high rates of recurrence and diagnostic challenges. Dissolution therapy plays a valuable role in the conservative management of UA calculi, reducing the requirement for surgical intervention. This review summarises the existing evidence for the efficacy of medical dissolution of uric acid urolithiasis.
A systematic search was conducted of worldwide literature according to PRISMA methodology and Cochrane standards for systematic review. Studies were included if they reported outcome data for the administration of medical therapy for the dissolution of UA calculi. A total of 1075 patients were included in the systematic review. Complete or partial dissolution of UA calculi was observed in 80.5% of patients (865/1075 patients), with 61.7% (647/1048 patients) achieving complete dissolution and 19.8% (207/1048 patients) achieving partial dissolution. A discontinuation rate of 10.2% (110/1075 patients) was noted, and 15.7% (169/1075 patients) required surgical intervention. Dissolution therapy is a safe and effective method of conservatively managing uric acid stones in the short term. Despite the significant disease burden of UA calculi, current guidelines are limited by deficiencies in the existing body of research. Further research should be undertaken to develop evidence-based clinical guidelines for diagnosis, treatment, and prevention of UA urolithiasis.
Current urology reports. 2023 Apr 20 [Epub ahead of print]
Andrea Ong, George Brown, Theodoros Tokas, B M Zeeshan Hameed, Joe Philip, Bhaskar K Somani
Department of Urology, University Hospital Southampton, Southampton, SO16 6YD, UK., Department of Urology and Andrology, General Hospital Hall I.T., Milser Str. 10, Hall in Tirol, 6060, Austria., Father Muller Medical College Hospital, Mangalore, India., Bristol Urological Institute, Southmead Hospital, Westbury-on-Trym, Bristol, BS10 5NB, UK., Department of Urology, University Hospital Southampton, Southampton, SO16 6YD, UK. .