Breaking Down Uric Acid Stones- Faster, Smarter, Safer

A fresh perspective on uric acid kidney stones- backed by data, not just tradition.

In a joint study with Wolfson & Sheba Medical Centers and Ariel University, led by Dr. Paz Lotan (MD, University of Wisconsin) Prof. David Lifshitz (Department of Urology, Rabin Medical Center) and Prof. Yitzhak Mastai, researchers conducted a comprehensive examination of uric acid stone dissolution, challenging long-held assumptions and providing practical updates to current treatment strategies.

Their findings? Small changes can make a big difference:

Raising urine pH to 7-7.2 significantly boosts stone dissolution, up to nine times faster than at lower pH levels. Even modest fragmentation of the stones drastically improves their dissolution rate, hinting at the value of minimally invasive preparation before or alongside medical therapy. Lowering uric acid levels in the urine only helps if alkalinization is already in place, supporting clinical guidelines that discourage allopurinol use alone in patients without high uric acid levels.

Why does this matter? These insights could reduce the need for surgery, especially in older or higher-risk patients, and help fine-tune treatment to be both more effective and safer. It also alleviates concerns about pushing urine pH too high; when done correctly, the risk of forming new types of stones remains low.

Hats off to Dr. Lotan and Prof. Mastai for bringing lab precision to clinical care. This is a great example of how re-examining the basics can move medicine forward.