ENDOSCOPIC MAPPING OF RENAL PAPILLAE FOR RANDALLS PLAQUES IN PATIENTSWITH URINARY STONE DISEASE

Purpose: Papillary ''Randall's plaques'' are theorized to act as nidi for urinary stone formation. The aim of this study was to document the presence, pattern and distribution of Randall's plaques in patients u ndergoing endoscopic procedures for urinary stone disease. Materials a nd Methods: Patients undergoing either ureteroscopy or percutaneous ne phroscopy for removal of urinary stones underwent endoscopic mapping o f accessible calices. These patients were compared to a smaller group of patients undergoing endoscopic procedures for conditions unrelated to urinary stone disease. In patients found to have papillary plaques the presence, location and pattern of plaques were recorded. Plaque fo rmation was correlated with patient age and sex, and primary compositi on of extricated stone. Results: Endoscopic evidence of papillary Rand all's plaques was found in 74% of 57 patients having ureteroscopic (21 ) or percutaneous (36) stone removal. Of 7 patients having endoscopic procedures for conditions unrelated to urinary stone disease 3 (43%) h ad evidence of papillary plaques. Plaques were found uniformly through out all calices and most commonly diffusely scattered over the papilla ry surface. There was no correlation between patient age or sex and th e presence of plaques. The incidence of plaques varied with the primar y composition of extracted stones, and was 100% for calcium phosphate and uric acid, 88% for calcium oxalate, 33% for cystine and 20% for st ruvite. The incidence of papillary plaques was significantly more comm on in patients with calcium oxalate (88 versus 43%, p = 0.023) and cal cium phosphate stones (100 versus 43%, p = 0.009) than patients withou t a history of urinary stone disease. Conclusions: The endoscopic inci dence of papillary Randall's plaques in patients with urolithiasis var ies with the primary composition of formed urinary stones. Randall's p laques are found in the majority of patients with calcium urinary ston e disease. Our findings suggest that the presence of papillary plaques is associated with calcium nephrolithiasis and may contribute to the pathogenesis of calcium urinary stones.