Urine alkalinization for dissolution of uric acid stones and treatment of other urological diseases with a treatment combining potassium magnesium citrate and theobromine.

Abstract

Background: Urine alkalinization can be used for the treatment of some urological diseases.

Methods: A series of cases showing the beneficial effects of urine alkalinization with potassium magnesium citrate, theobromine, zinc and vitamin A for the dissolution of uric acid stones and the treatment of other urological pathological conditions is presented.

Results: Alkalinization was effective in the dissolution of uric acid renal stones in various clinical conditions. Two cases of bilateral renal stone, four cases of staghorn renal stone, seven patients with unilateral renal stone, and five cases of ureteral stone were described. In this group the age ranged from 46 to 91 years, the M/F ratio was 7/11, the density of the stones ranged between 300 and 528. In most cases the urinary pH ranged from 5 to 5.5. Diabetes was observed in 4 cases, obesity in 4 cases and hyperuricemia in 7. Alkalinizing treatment achieved complete dissolution of the stone in 12 cases and almost complete or partial dissolution in other 6. A combination of potassium magnesium citrate, theobromine, zinc and vitamin A was used in all the cases.  In 4 cases the administration of allopurinol was associated. In one case with obstructive ureteral stones, stone dissolution was obtained with the combined administration of bicarbonate via nephrostomy and intravenous bicarbonate and oral treatment with citrates.  Stone dissolution of uric acid stones has also been described in some specific clinical conditions such as Crohn's disease with ileostomy, outcome of partial nephrectomy, cross-fused renal ectopia. Alkalinization was also used to prevent encrustation of a self-expanding metallic ureteral stent. Alkalinization has also been employed during the period of Mitomycin administration for the treatment of non-muscle infiltrating bladder tumors and for the treatment of overactive bladder.

Conclusions: The findings of these case reports demonstrate that urinary alkalinization with frequent monitoring of urinary pH ​can be successfully employed in the non-surgical treatment of uric acid stones of different sizes in various locations.