Urolithiasis in Malignant Hematologic Diseases MATERIALS AND METHODS Nine hundred one patients from the Hematologic Depart- ment who received medical treatment for malignant hema- tologic diseases between July 2003 and June 2005 were included in our study, and 40,543 patients who visited the emergency room during that same period without malig- nant hematologic diseases were included in the control group. Of the 901 evaluable patients with malignant hemato- logic diseases, the median age at the time of diagnosis was 46 years (age range: 20 to 67 years) and that of the 40,543 patients was 46 years (age range: 20 to 94 years). The ratio of male to female was 0.93 : 1 and 0.96 : 1 in the patients group and control group, respectively. The patients with malignant hematologic diseases-were only enrolled after July 2003 and we excluded the patients with a history of urolithiasis before making the diagnosis of malignant hematologic diseases. The patients with malignant hematologic diseases were divided into two groups depending on their main treatment: group I (n = 520) included acute and chronic leukemia which needed chemotherapy and glucocorticoid therapy, and group II (n = 379) included patients with anaplastic anemia and myelodysplastic syndrome and who had undergone repeated blood transfusions for treatment. We investigated the presence of chemotherapy and glucocor- ticoid therapy, the number of blood transfusions, and the incidence rate of urolithiasis for each group. The diagnosis of urolithiasis was confirmed by excretory urography or abdominal computerized tomography (CT) for the patients who visited our department due to symptoms of uroli- thiasis-like flank pain and/or hematuria. Comparisons were made between the two groups with respect to the incidence of urolithiasis and the stones’ nature by radiopacity through Plain film of the kidney, ureter, and bladder (KUB). The patients were retrospectively identified by a com- puter-assisted review of the medical charts and by using an image recording system. Fisher’s exact test was used to analyze the data for statistics. p values < 0.05 were regarded as significant. RESULTS Twenty nine (3.2%) of the 901 patients with malignant hematologic diseases were diagnosed with urolithiasis, compared to 575 (1.4%) of the 40,543 general patients who visited the emergency room. The incidence of uroli- thiasis of the malignant hematologic group significantly increased (p = 0.043) (Fig. 1). The incidence of urolithiasis Fig. 1. Comparison of the stone incidence in the study group and the control group. Study group: patients of malignant hematologic disease, Control group: patients who visited the emergency room (p = 0.04). Table 1. Characteristics of the Stone Patients with Malignant Hematologic Diseases and Stones Group I (n = 15) Group II (n = 14) Age (mean) 47.2 36.8 Gender (M : F) 10 : 5 6 : 8 Steroid therapy 53.3% (8 / 15) 71.4% (10 / 14) Chemotherapy 86.7% (13 / 15) 0.0% (0 / 14) Transfusion 20% (3 / 15) 100% (14 / 14) Type of diseases AML : 2 MDS : 3 ALL : 4 AA : 12 CML : 6 CLL : 2 I AML, acute myeloblastic leukemia; ALL, acute lymphatic leukemia; CML, chronic myeloblastic leukemia; CLL, chronic lymphatic leukemia; MDS, myelodysplastic syndrome; AA, aplastic anemia. Group I, acute or chronic leukemia; Group II, anaplastic anemia or myelo- dysplastic syndrome. in group I and group II was 2.9% (15/520) and 3.7% (14/381), respectively. Although the latter was higher than the former, there was no significant difference (p = 0.181) The median age of the 29 patients who were confirmed with urolithiasis and malignant hematologic diseases was 45.3 years (range: 21 years-66 years), and the gender ratio (male : female) was 1.14 to 1 (Table 1). The size of the stones was 4.3 ± 0.8 mm. The most common site was the upper ureter (41.4%, 12/29) and the main symptoms were flank pain and gross hematuria 43.3% and 36.6%, respec- tively (Table 2). The initial therapy for urolithiasis in the group of general patients was electric shock wave lithotripsy (ESWL) or ureteroscopic lithotripsy [64.0% (345/575)], while that in the group of malignant hematologic diseases was conservative therapy [55.2% (16/29)], ESWL [37.9% (11/29)] and ureteroscopic lithotripsy [6.8% (2/29)]. Compared to the general patients, the patients with malig- nant hematologic diseases had a higher rate of radiolucent stones [44.8% (13/29) versus 14.9% (86/575)], and the Yonsei Med J http://www.eymj.org Volume 51 Number 2 March 2010 245