الفهرس 
Epidemiolog yOnly 14 pages are availabe for public view
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Abstract
Recurrent urinary calculi is that stone that recur after surgical or endoscopic removal of the stone or fragmentation of the stone with ESWL. The common site for recurrence is the kidney itself but it my also occur at anywhere including the bladder. (Sun et al, 2007)
During the last ten years, the overall adjusted relative recurrence rate (ARRR) is 35.3%. The importance of an exact physical analysis of urinary stones, involving a differentiation of the various Ca oxalates and Ca phosphates, becomes clear looking at the high recurrence rates for the monomineralic stones of the Ca stone. Dramatic changes in the composition of the recurrent stone were observed only in 12.7% of all cases. The highest ARRR was found in infection stones with a large content of struvite (about 75%), whereas the total recurrence rate of the infection stone class was about 38%. An assessment of the danger of a urinary stone taking into account the criteria of composition and prevalence to recur is given. (Leusmann et al 2005)
Risk factors for recurrent stones includes: hot climate, diet types, infection, parathyroid gland diseases, low urine volume, elevated urinary oxalate excretion, elevated urinary calcium excretion, elevated urinary uric acid excretion , Low urinary level of inhibitors of stone formation, particularly citrate , Low or high urine pH , Urine stasis and infection . (J y et al, 2003)
The use of antibiotics significantly affected the incidence of recurrent struvite calculi. In particular, if prolonged prophylactic antibiotics (greater than 3 months) were used 15 percent of the patients had recurrent stones, compared to 90 percent if only preoperative antibiotics less than 15 days were used with p less than 0.001. (Jiaan et al 2006).
Metabolic evaluation of patients with nonstruvite calculi revealed that 76 percent had an identifiable metabolic abnormality, treatment of which significantly decreased the incidence of recurrent renal calculi: 17 percent of the patients on interventional therapy had recurrent stones compared to 55 percent treated by observation alone .(Sutherland et al, 2002)
It was always presumed that ESWL would increase the risk of calculus recurrence. The cause was thought to be persistent small calculus fragments after ESWL.
Prevention strategies to prevent recurrence of stones are: - increase fluid intake to produce 2–3 L of urine daily, decrease dietary oxalate (spinach, rhubarb, chocolate, nuts and cranberries), decrease intake of animal protein, restrict sodium
(< 100 mmol/d [2–3 g/d]) rather than calcium (should be 1 g/d).
Evaluations of patient with recurrent stone formation (and all children) are Twenty-four ¬hour urine collection: volume, pH, and levels of calcium, phosphorus, sodium, uric acid, oxalate, citrate, creatinine, calcium oxalate (super saturation), calcium phosphate and uric acid. (Huet et al 2005)
The management of recurrent urinary stone includes prophylaxis against recurrence or treatment of already recurrent stone surgically. Examples of the drugs used in prophylaxis are thiazides, potassium citrate and allopurinol (Zyloprim) and the use of this prophylactic medical therapy produce resultant significant reduction in urologic procedures and hospitalizations per patient per year. Given the proven benefit of prophylaxis.
(Jt et al, 2004)