Frontiers in Medicine (Oct 2023)

In focus: perplexing increase of urinary stone disease in children, adolescent and young adult women and its economic impact

  • Guido Filler,
  • Guido Filler,
  • Guido Filler,
  • Sumit Dave,
  • Victor Ritter,
  • Sherry Ross,
  • Davis Viprakasit,
  • Joseph E. Hatch,
  • Jennifer Bjazevic,
  • Jeremy Burton,
  • Jeremy Burton,
  • Donna Gilleskie,
  • Jason Gilliland,
  • Feng-Chang Lin,
  • Nina Jain,
  • J. Andrew McClure,
  • Hassan Razvi,
  • Vipin Bhayana,
  • Peter Wang,
  • Sherry Coulson,
  • Nabil Sultan,
  • John Denstedt,
  • Loretta Fearrington,
  • Maria E. Diaz-Gonzalez de Ferris

DOI
https://doi.org/10.3389/fmed.2023.1272900
Journal volume & issue
Vol. 10

Abstract

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BackgroundUrinary stone disease (USD) historically has affected older men, but studies suggest recent increases in women, leading to a near identical sex incidence ratio. USD incidence has doubled every 10 years, with disproportionate increases amongst children, adolescent, and young adult (AYA) women. USD stone composition in women is frequently apatite (calcium phosphate), which forms in a higher urine pH, low urinary citrate, and an abundance of urinary uric acid, while men produce more calcium oxalate stones. The reasons for this epidemiological trend are unknown.MethodsThis perspective presents the extent of USD with data from a Canadian Province and a North American institution, explanations for these findings and offers potential solutions to decrease this trend. We describe the economic impact of USD.FindingsThere was a significant increase of 46% in overall surgical interventions for USD in Ontario. The incidence rose from 47.0/100,000 in 2002 to 68.7/100,000 population in 2016. In a single United States institution, the overall USD annual unique patient count rose from 10,612 to 17,706 from 2015 to 2019, and the proportion of women with USD was much higher than expected. In the 10–17-year-old patients, 50.1% were girls; with 57.5% in the 18–34 age group and 53.6% in the 35–44 age group. The roles of obesity, diet, hormones, environmental factors, infections, and antibiotics, as well as the economic impact, are discussed.InterpretationWe confirm the significant increase in USD among women. We offer potential explanations for this sex disparity, including microbiological and pathophysiological aspects. We also outline innovative solutions – that may require steps beyond typical preventive and treatment recommendations.

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