Do probiotics help prevent stones?

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The above is a calcium oxalate stone in the ureteral orifice just about to fall into the bladder…no wonder they hurt. The green tint you see is the laser fiber beam which will be used to fragment the stone.

Probiotic Supplements Sold on Internet Unlikely to Benefit Stone Patients

Urology – July 30, 2015 – Vol. 32 – No. 12

Current probiotic supplements marketed to reduce oxalate stone formation do not contain the active ingredients advertised.

Article Reviewed: Analysis of Commercial Kidney Stone Probiotic Supplements. Ellis ML, Shaw KJ, et al: Urology; 2015;85 (March): 517-521.

Objective: To determine the levels of Oxalobacter formigenes and the oxalate-degrading ability in probiotic supplements (PRO-LAB from Toronto, Canada, and Oxalo from Hyderabad, India) marketed to reduce kidney stone recurrence in stone-forming patients.

Design: Prospective in-vitro study.

Methods: Probiotic supplements obtained from PRO-LAB and Oxalo were cultured in a number of different medias. Optical density was used to measure bacterial growth, while ion chromatography was used to measure loss of oxalate in media. Polymerase chain reaction (PCR) was used to determine organism species.

Results: No growth of oxalate-degrading organisms occurred. PCR showed that the PRO-LAB supplement contained Lactococcus lactisand Oxalo contained several Bacillus species and Lactobacillus plantarum.

Conclusions: Current probiotic supplements did not contain O formigenes or other oxalate-degrading organisms and are unlikely to benefit calcium oxalate kidney stone patients.

Reviewer’s Comments: Much work is being performed in an attempt to provide O formigenes as a probiotic supplement in hopes of reducing urinary oxalate excretion in calcium oxalate stone-forming patients. However, it has proven very difficult to get viable O formigenes organisms to the intended site for colonization in patients. The current marketed formulations over the Internet (PRO-LAB and Oxalo) have no resemblance to organisms containing oxalate-degrading properties. These probiotics are a waste of money for patients and they should not be recommended for use. This study reminds us to use caution in recommending or purchasing any product that is not regulated by the Food and Drug Administration since no quality measures are required for supplements and the product is often not as advertised.(Reviewer–David A. Duchene, MD).

Stone prevention? Water, Water, Water!

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Some people will buy a 24 pack of bottled water and keep in a cool place in their car and drink a bottle every time they get in or out of their car. Ideas like this are helpful in making sure you are well hydrated. JM

Only Half of First-Time Stone Formers Achieve Stone Prevention Targets for Fluid Intake, UV

Urology – December 30, 2017 – Vol. 36 – No. 2

Approximately 50% of first-time stone formers achieve compliance targets for fluid intake and urine volume (UV). Factors decreasing compliance include initial UV <1 L, older age, female gender, and the presence of lower urinary tract symptoms.

Article Reviewed: Factors Associated With Compliance to Increased Fluid Intake and Urine Volume Following Dietary Counseling in First-Time Kidney Stone Patients. Khambati A, Matulewicz RS, et al: J Endourol; 2017;31 (June): 605-610.

Background: Fluid intake is critical for kidney stone prevention. Not all patients are compliant with this recommendation despite its effectiveness.

Objective: To evaluate compliance with fluid intake and urine volume (UV) recommendations in patients with nephrolithiasis and assess factors influencing compliance.

Design: Retrospective study.

Methods: Between 2010 and 2015, first-time kidney stone patients with UV <2.5 L/d on initial 24 hour urine were reviewed. Patients received instruction on strategies to increase fluid intake and target goals of >3 L/d fluid intake and >2.5 L/d UV. Repeat 24 hour urine collections were obtained at 6 and 18 months. Demographic and clinical data were analyzed to determine factors associated with compliance.

Results: 363 patients were included in the study. Mean baseline UV was 1.63 L/d, which increased to 2.5 L/d at 6 months. The compliance rate for UV >2.5 L/d at 6 months was only 50.1%, and decreased to 47.5% at 18 months. Overall, 30 patients (8.3%) had UV <1L/d, and only 20% of these patients reached the target 2.5 L/d at 6 months compared to 50.2% of patients with baseline UV of 1 to 2 L/d, and 61.8% of patients with baseline UV of 2 to 2.5 L/d (P =0.001). Factors associated with increased compliance included male gender (odds ratio [OR], 3.27), surgical procedures for stones (OR 2.3 to 3.5), and baseline UV >1L/d (OR, 3.0). Lower compliance was seen for patients aged >58 years and those with lower urinary tract symptoms (LUTS) (OR, 0.39 and 0.50).

Conclusions: Approximately 50% of first-time stone formers achieve compliance targets for fluid intake and urine volume. Factors decreasing compliance include initial UV <1 L/d, older age, female gender, and the presence of LUTS.

Reviewer’s Comments: When I ask my recurrent stone formers what advice they have been given for stone prevention, I often hear “my doctor only told me to increase fluids.” It occurs to me that patients do not understand the importance of increasing fluid intake and in turn urine volume. Of all the strategies we preach for stone prevention, fluid intake is one of the few that have randomized controlled trial data to support it. It is important to explain that UV is even more important than intake as insensible losses differ from patient to patient; therefore, UV will also differ between patients with the same fluid intake.

The current study assists in understanding which patients are likely to need additional instruction to achieve compliance.In the technology age, there are aides to help patients including apps for mobile devices and attachments for water bottles that flash to remind a patient to drink.

This study also illustrates how as urologists we need to assess and treat patients with LUTS, which can greatly influence compliance with fluid recommendations particularly given the significant impact LUTS have on quality of life.(Reviewer–Nicole L. Miller, MD).

 

Author: Khambati A, Matulewicz RS, et al
Author Email: aziz.khambati@medportal.ca