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. 2025 Jun 11;25(1):1–12. doi: 10.4103/aam.aam_54_25

Diversity in Clinical Characteristics and Composition of Urinary Stones in Different Regions of India and Comparison to Rest of the World

Prem Kumar 1,✉, Pranjal Prem 1, Amitabh Kumar Sinha 1, Shamim Ahmad 1
PMCID: PMC12872136  PMID: 40495432

Abstract

Urinary stones are a common urological condition that exhibits significant variability in prevalence, clinical presentation, and composition across different geographic regions. In India, the condition affects approximately 2 million individuals annually, with notable regional differences driven by dietary habits, environmental factors, and socioeconomic conditions. This study comprehensively reviews the clinical characteristics, urinary stone composition, and associated risk factors in India while comparing these findings with global trends. The data for this review were obtained through an extensive analysis of the available literature on urinary stone composition and clinical characteristics in India and various countries worldwide. Sources included multiple databases such as Springer, Scopus, Elsevier, Google Scholar, Wiley, Web of Science, PubMed, and Taylor and Francis. The data were synthesized to assess the prevalence, composition, and risk factors of urinary stones by region, and these were compared with international data. Mixed stones were more commonly observed in northern and coastal regions, while uric acid (UA) stones showed a higher prevalence in the southern states. Globally, calcium oxalate (CaOx) remained the dominant stone type, but certain regions exhibited a higher occurrence of struvite and UA stones, largely attributed to specific dietary patterns and infection rates. The study concludes that urinary stone composition in India varies regionally due to dietary habits, hydration, and environmental factors. While CaOx remains prevalent globally, other stone types show distinct regional differences. Targeted prevention through hydration and dietary modifications is crucial, and future research should explore genetic predispositions and the impact of climate change on stone formation.

Keywords: Prevalence in India and world, regional variability, urinary stone

INTRODUCTION

Urinary stone disease is a common urological condition worldwide, characterized by the formation of stones in the kidneys, bladder, and urinary tract. It can lead to severe pain, infection, and kidney damage if left untreated. The management of urinary stone disease includes various treatment options such as shock wave lithotripsy, ureteroscopy, and percutaneous nephrolithotomy.[1,2] Estimates suggest that 3%–20% of the population will develop urinary stones during their lifetime, with recurrence rates reaching 10% within 1 year, 50% over 5–10 years, and 75% over 20 years.[3]

In India, it affects approximately 2 million people annually, with a particularly high prevalence in the northwestern regions. This high prevalence is attributed to dietary habits, environmental factors, and genetic predisposition. It is crucial for healthcare providers to consider these factors when developing treatment plans for patients with urolithiasis in India.[4]

Environmental factors such as high temperatures, low fluid intake, reliance on mineral-rich groundwater, and dietary habits rich in oxalates, calcium, and spicy foods significantly contribute to stone formation.[5]

Urbanization has introduced metabolic risk factors such as diabetes and obesity, leading to a rise in uric acid (UA) stones. These sociocultural, dietary, and environmental factors emphasize the importance of region-specific research.[6]

Despite extensive global research, there remains a gap in understanding the regional diversity of urinary stone composition and clinical characteristics. While global reviews provide valuable insights into prevalence and stone types, limited literature focuses on the variations within India and their comparison to global trends.[7]

This review aims to analyze urinary stone composition and clinical characteristics across different regions of India in relation to global patterns. The findings will help identify region-specific risk factors, supporting targeted strategies for diagnosis, treatment, and prevention.

URINARY SYSTEM AND STONE FORMATION

The kidneys maintain homeostasis by filtering blood and excreting waste products through urine. Factors such as the supersaturation of urine with stone-forming ions, including calcium, oxalate, and UA, as well as insufficient inhibitors like citrate, disrupt this balance and promote crystal nucleation and aggregation.[8]

Stone formation can occur in different parts of the urinary tract, such as the kidneys, ureters, bladder, and urethra. Multiple factors, including genetic predisposition, dietary habits, lifestyle choices, and medical conditions such as urinary tract infections (UTIs) or metabolic disorders, influence the process.[9] Different locations of urinary stones are depicted in Figure 1.

Figure 1.

Figure 1

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Urinary system showing stone at different locations

TYPES OF URINARY STONE

Based on composition, they are classified as:

Calcium stones

Calcium stones are the most common type and account for approximately 80% of all urinary stones. Calcium oxalate (CaOx) stones, which comprise over 60% of calcium stones, exist in two forms: monohydrate (whewellite) and dihydrate (weddellite). These stones typically form when urinary pH ranges from 5 to 6.5.[10]

Calcium phosphate (CaP) stones form when the urine pH is above 7.5, and it accounts for about 5% of all stones. The rest are mostly a combination of CaOx and CaP.[11,12] Metabolic disorders such as hypercalciuria, hyperoxaluria, and hypocitraturia often cause calcium stone formation. They have a high recurrence rate, unlike other stone types.[13,14,15]

Cystine stones

They make up <2% of all stones and are caused by a hereditary disorder affecting cystine (CYS) and amino acid transport. This autosomal recessive disorder is due to a mutation in the rBAT gene on chromosome 2. It causes cystinuria, which leads to CYS stone formation.[16]

Struvite stones

These are also known as magnesium ammonium phosphate (MAP) stones or infection stones and account for 10%–15% of cases. They are commonly associated with chronic UTIs caused by urease-producing bacteria.[17] Alkaline urine causes phosphate to precipitate, forming large staghorn calculi.[18]

Uric acid stones or urate

These stones make up 3%–10% of all stone kinds. Purine-rich diets high in animal proteins such as meat and fish lead to hyperuricosuria. Idiopathic causes of low urine volume and low urinary pH are leading causes of UA stones.[19]

Xanthine stones

This rare kidney stone results from xanthinuria, a rare genetic disorder characterized by a deficiency in xanthine (XAN) oxidase, leading to hypouricemia and hypouricosuria. It is an uncommon cause of stone formation in children in many cases.[19,20] The different types of urinary stones are shown in Figure 2.[21]

Figure 2.

Figure 2

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Types of urinary stone (a) Calcium oxalate monohydrate with calcium oxalate dihydrate (b) Cystine (c) Struvite (d) Uric acid (e) Carbonate apatite (f) Calcium oxalate monohydrate (g) Ammonium hydrogen urate (h) Stone over double-J stent (pure carbonate apatite)

MECHANISM OF URINARY STONE FORMATION

Biomineralization, a complex and enigmatic process, involves physiological changes and urine supersaturation, which in turn leads to the formation of urinary stones.[22] The conversion from a liquid to a solid phase is generally encouraged by pH levels and specific concentrations of excess constituents. The level of urinary saturation with respect to stone-forming constituents such as calcium, phosphorus, UA, oxalate, and CYS, as well as low urine volume, is the main risk factors for stone formation. It is important to emphasize that the degree of imbalance between urinary inhibitors and crystallization promoters usually determines the likelihood of stone development. In healthy individuals, inhibitory chemicals prevent crystallization. The process that leads to urinary stones includes crystal nucleation, growth, aggregation, and retention,[23] as shown in Figure 3.

Figure 3.

Figure 3

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Schematic diagrammatic representation of the mechanism of urinary stone production

SUMMARY OF URINARY STONE STUDIES IN INDIA

Urinary stones, a prevalent and often painful condition, show significant regional variations in their composition, clinical presentation, and associated risk factors. The studies summarized in Table 1 provide a comprehensive overview of the diversity in urinary stone occurrence across various regions of India. These studies highlight not only the dominant types of stones found but also regional factors such as diet, gender distribution, age demographics, and lifestyle practices that influence stone formation [Table 1].

Table 1.

Summary of Indian studies

Author and year Region Patient numbers Key findings
R. Kumar et al. (2003)[24] Lucknow, Uttar Pradesh 100 Higher urinary oxalate, calcium, and uric acid levels in stone formers.
Hypocitraturia and hyperoxaluria were common. Recurrent cases had higher urinary calcium and lower citrate
Ansari, MS et al. (2005)[25] New Delhi 1050 Calcium oxalate stones (primarily monohydrate) were predominant. 89.98% of staghorn stones are composed of oxalates
T.V.R.K. Rao et al. (2006)[29] Bihar 152 Male predominance was observed, with the highest incidence in 35–44 years of age group. Upper urinary tract stones were more common. Mixed composition stones, predominantly composed of calcium oxalate were most frequently identified. In addition, the incidence among adolescents is rising
Shalmoli et al. (2014)[34] Chandigarh, Punjab 52 Male predominance with increasing age. Stones were mostly oxalate or mixed types, identified through spectrum analysis
Madhusudan et al. (2015)[35] Karnataka 29 Rural prevalence is higher. Risk factors included groundwater consumption and high temperatures among agricultural workers
Surinder K. Sharma et al. (2015)[28] Kochi, Kerala 176 Renal stones are most common, followed by ureteric and bladder stones. 32% had elevated serum creatinine; 36% had high uric acid
Sofia et al. (2016)[36] Chennai 666 Male predominance. Low fluid intake, obesity, diabetes, and hypertension are linked to stone formation. Lifestyle changes can reduce recurrence
Dongre et al. (2017)[30] Puducherry 70 patients, 140 controls Genetic predisposition and red meat consumption linked to stone formation. Water hardness is not associated with stone risk
Muhammad A. et al. (2017)[31] Mangalore 369 Over 50% had mixed stones. Calcium oxalate is linked to high serum calcium. Uric acid stones are linked to high blood sugar and uric acid levels
Lohiya et al. (2017)[38] Haryana 433 High burden of stones in the working-age population. Untreated stones lead to emergencies or long-term complications
Nerli et al. (2018)[26] Karnataka, Goa, Maharashtra 250 Urinary stone are prevalent. Goa had the highest incidence of uric acid stones and low urinary pH. Dietary differences were noted across regions
Mitra et al (2018)[27] West Bengal 1233 Water quality was not a factor. The amount of water consumed was crucial for preventing stones
A. Bhat et al. (2018)[39] Jaipur, Rajasthan 1005 Calcium oxalate stones most common across all age groups. Mixed stones are more frequent than pure stones. Struvite and uric acid stones decreased with age
J. Sunitha et al. (2018)[40] Vellore, Tamil Nadu 130 Age, gender, dietary habits, smoking, and alcohol were major risk factors for stone formation and their recurrence
Prakash R. et al. (2019)[32] Thanjavur, Tamil Nadu 150 Calcium oxalate stones are the most common. Risk factors: Diet, age, obesity, genetics, climate, and lifestyle
Faridi MS et al. (2020)[37] Manipur 621 Obesity, sedentary lifestyle, smoking, and alcohol use were identified as common risk factors
Monica et al. (2021)[33] Uttarakhand 435 Male-to-female ratio~3:1. ~90% of stones which was composed of calcium oxalate, predominantly found in kidneys
Sonali et al. (2022)[34] Jodhpur, Rajasthan 207 Dietary factors played a key role in stone formation. Simple dietary modifications significantly reduced risk
Kumar P et al. (2024)[21] Jharkhand 1231 The highest incidence is in the early middle-aged. Low animal protein intake, proper hydration, and lifestyle changes reduced recurrence
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AGE RANGES FOR URINARY STONE INCIDENCE ACROSS INDIAN STATES

Studies conducted in India reveal variations in the age distribution of urinary stone occurrence. However, age range data are not reported in studies from regions such as Lucknow,[24] New Delhi,[25] Goa/Maharashtra,[26] West Bengal,[27] and Kochi.[28] Most studies show a higher prevalence of urinary stones among individuals aged 21–40 years, with regional differences. For instance, Bihar,[29] Puducherry,[30] Mangalore,[31] Thanjavur (Tamil Nadu),[32] and Uttarakhand[33] report the highest prevalence within this age group. In Chandigarh,[34] the prevalence is highest among those over 30 years, while Karnataka,[35] Tamil Nadu (Chennai),[36] Manipur,[37] and Jharkhand[21] primarily found cases in the 31–40 years of age group. In Haryana,[38] individuals aged 21–30 years are most affected, whereas in Jaipur, Rajasthan,[39] cases typically begin after the age of 20. In Vellore, Tamil Nadu,[40] the majority of cases occur in the 31–50 age group. These patterns underscore the role of lifestyle, occupational exposures, and environmental factors in stone formation during the most active years of life. The consistency of these findings across diverse regions highlights the need for targeted preventive strategies focused on middle-aged populations, who are at the highest risk of developing urinary stones [Table 2].

Table 2.

Age range prevalence for urinary stone in Indian prospective

Age range Total
1–10, n (%) 11–20, n (%) 21–30, n (%) 31–40, n (%) 41–50, n (%) 51–60, n (%) 61–70, n (%) 71–80, n (%) 81–90, n (%)
Lucknow --* 100
New Delhi -- 1050
Bihar 190 (17.8) 457 (43.03) 257 (24.1) 158 (14.8) 1062
Chandigarh 6 (11.5) 9 (17.3) 37 (71.1) 52
Karnataka 2 (6.9) 5 (17.2) 7 (24.1) 9 (31.0) 4 (13.8) 2 (6.9) 0.0** 0.0 0.0 29
Kochi -- 176
Chennai, Tamil Nadu 0.0 9 (1.35) 167 (25.0) 217 (32.6) 166 (24.9) 67 (10.0) 35 (5.25) 5 (0.75) 0.0 666
Puducherry 0.0 0.0 35 (50.0) 19 (27.1) 16 (22.2) 0.0 70
Mangalore 17 (4.6) 149 (40.4) 160 (43.3) 43 (11.7) 369
Haryana 0.0 38 (8.8) 127 (29.4) 115 (26.5) 51 (11.8) 38 (8.8) 51 (11.8) 13 (3.0) 433
Goa/Maharashtra -- 250
West Bengal -- 1266
Jaipur, Rajasthan 163 (16.2) 842 (83.8) 1005
Vellore, Tamil Nadu 29 (37.7) 66 (85.5) 27 (35.1) 0.0 130
Thanjavur, Tamil Nadu 1 (1.0) 46 (46.0) 46 (46.0) 7 (7.0) 0.0 100
Manipur 0.0 22 (3.5) 127 (20.4) 156 (25.1) 137 (22.0) 105 (16.9) 49 (7.9) 18 (2.9) 7 (1.1) 621
Uttarakhand 44 (10.1) 213 (48.9) 146 (33.5) 32 (7.4) 435
Jharkhand 35 (2.8) 51 (4.1) 286 (23.2) 343 (27.9) 244 (19.8) 171 (13.9) 88 (7.1) 9 (0.7) 4 (0.3) 1231
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*Not discussed in study, **0.0=No information found within the literature

REGIONAL FACTORS INFLUENCING URINARY STONE PREVALENCE IN INDIA

Urinary stone patients in India have different demographic and lifestyle traits based on their region. Male predominance is evident in most regions; however, exceptions were noted in Karnataka and Tamil Nadu (Thanjavur), where females outnumbered males.

Most studies have highlighted that low water intake promotes urinary stone formation. However, a significant number of cases were reported in Chennai and Western Rajasthan despite adequate water consumption. Dietary patterns showed significant variation across regions. Nonvegetarian diets were more prevalent in West Bengal and Chennai, while vegetarian diets were dominant in regions such as Jodhpur and Rajasthan.

Addictions such as smoking and alcohol consumption were reported in specific regions, including Karnataka, Chennai, Vellore, Puducherry, Manipur, Jodhpur, and Rajasthan, but they were not reported in other regions, as shown in Table 3.[20,40,41]

Table 3.

Risk factors for urinary stone in Indian regions

Sex Addiction Dietary habit Water intake Total (n)
Male Female Alcohol Smoking Veg Nonveg Less Adequate
Lucknow 90 (90.0) 10 (10.0) 0.0 0.0 0.0 0.0 0.0 0.0 100
New Delhi 700 (66.6) 350 (33.3) 0.0 0.0 0.0 0.0 0.0 0.0 1050
Bihar 780 (73.4) 282 (26.6) 0.0 0.0 0.0 0.0 0.0 0.0 1062
Chandigarh 38 (73.0) 14 (27.0) 0.0 0.0 0.0 0.0 0.0 0.0 52
Karnataka 23 (44.0) 6 (56.0) 12 (24.0) 10 (20.0) 20 (40.0) 30 (60.0) 0.0 0.0 50
Kochi 112 (64.3) 64 (36.8) 0.0 0.0 0.0 0.0 0.0 0.0 176
Chennai, Tamil Nadu 430 (64.5) 236 (35.4) 285 (42.8) 277 (41.2) 39 (5.8) 17 (2.6) 154 (23.1) 512 (76.9) 666
Puducherry 50 (71.4) 20 (28.6) 26 (37.1) 29 (41.4) 43 (61.4) 20 (28.6) 0.0 0.0 70
Mangalore 305 (82.7) 64 (17.3) 0.0 0.0 0.0 0.0 0.0 0.0 369
Haryana 224 (51.7) 209 (48.3) 0.0 0.0 0.0 0.0 0.0 0.0 433
Goa/Maharashtra 175 (70.0) 75 (30.0) 0.0 0.0 0.0 0.0 0.0 0.0 250
West Bengal 781 (61.7) 485 (38.3) 0.0 0.0 122 (9.6) 1144 (90.4) 678 (53.6) 588 (46.4) 1266
Jaipur, Raj 714 (71.0) 291 (29.0) 0.0 0.0 0.0 0.0 0.0 0.0 1005
Vellore, Tamil Nadu 44 (57.2) 22 (28.6) 5 (3.8) 9 (6.9) 86 (66.1) 43 (33.1) 0.0 0.0 130
Thanjavur, Tamil Nadu 44 (44.0) 56 (56.0) 24 (24.0) 20 (20.0) 40 (40.0) 60 (60.0) 0.0 0.0 100
Manipur 314 (50.5) 307 (49.5) 142 (22.9) 3 (0.5) 0.0 0.0 0.0 0.0 621
Uttarakhand 328 (75.4) 107 (24.5) 0.0 0.0 0.0 0.0 0.0 0.0 435
Jodhpur, Rajasthan 73 (68.9) 33 (31.1) 11 (10.3) 24 (22.6) 76 (71.7) 30 (28.3) 39 (36.8) 67 (63.2) 106
Jharkhand 876 (71.2) 355 (28.8) 0.0 0.0 0.0 0.0 0.0 0.0 1231
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All the presented data are expressed as - n (%)

COMPOSITION OF URINARY STONE IN DIFFERENT REGIONS OF INDIA

CaOx emerged as the predominant component in nearly all regions, with the highest prevalence observed in New Delhi (93.0%), Lucknow (88.0%), and Kochi (85.4%). A relatively lower proportion of CaOx stones was noted in Jaipur (25.1%), Mangalore (26.5%), and Karnataka (31.0%), where mixed stone compositions were more frequent.

Struvite (MAP) and carbonate apatite (Co3Ap) were detected in select regions, with notable occurrences in New Delhi (1.8%), Chandigarh (4.0%), and Karnataka (17.2%). Interestingly, West Bengal reported a significant proportion of MAP stones (20.0%), while this composition was absent in many other regions.

UA stones were reported in multiple regions, albeit in relatively lower proportions. The highest prevalence was recorded in Chennai (14.0%) and Mangalore (8.4%), while smaller proportions were found in Jharkhand (1.2%) and Uttarakhand (1.1%). The presence of ammonium hydrogen urate was largely restricted to a few regions, such as Karnataka (24.1%) and Jharkhand (1.8%).

Mixed stone compositions exhibited substantial regional variation. Jaipur (74.8%), Mangalore (52.8%), and Jharkhand (32.3%) reported the highest proportions of mixed stones.

Rare stone types, including CYS and XAN, were sparsely distributed. These components were documented in select regions such as Jharkhand (CYS: 1.38%) and Mangalore (CYS: 0.5%), reinforcing their low prevalence in the Indian population.

Data for certain states, including Puducherry, Haryana, Goa/Maharashtra, Manipur, and Jodhpur, were not discussed in the respective studies [Figure 4].

Figure 4.

Figure 4

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Regional comparison of urinary stone composition in India. CaOx: Calcium oxalate, Co3Ap: Carbonate apatite, MAP: Magnesium ammonium phosphate, AHU: Ammonium hydrogen urate, UA: Uric acid, CHP: Calcium hydrogen phosphate, CYS: Cystine, XAN: Xanthine, MHP: Magnesium hydrogen phosphate

AGE DISTRIBUTION OF URINARY STONE CASES AROUND THE WORLD

The age-wise distribution of urinary stone cases exhibited significant regional variation, as summarized in Table 4. In India,[21] the highest prevalence was observed in the 31–40 years of age group (27.9%), followed by the 21–30 years of age group (23.2%), with cases progressively decreasing in older age groups. This trend indicates that urinary stone occurrences peak among younger and middle-aged adults, likely due to dietary and lifestyle influences. Neighboring countries such as Pakistan[42] reported the highest prevalence in the 20–40 years of age group (47.6%), followed by the 41–60 years of age group (31.6%). Similarly, Bangladesh[43] (41.4%) and Saudi Arabia[44] (29.9%) reported a peak of cases in the 41–50 years of age group following the 31–40 years of age group. Countries such as Morocco[45] and Ireland recorded most cases within the 31–60 years of age range.[46]

Table 4.

Global age specific urinary stone prevalence

Age range Total, (n)
1–10, n (%) 11–20, n (%) 21–30, n (%) 31–40, n (%) 41–50, n (%) 51–60, n (%) 61–70, n (%) 71–80, n (%)
United States 0.0 0.0 0.0 69,936 (70.0) 0.0 99,908
India 35 (2.8) 51 (4.1) 286 (23.2) 343 (27.9) 244 (19.8) 171 (13.9) 88 (7.1) 9 (0.7) 1231
Sri Lanka --* 100
Pakistan 157 (11.8) 633 (47.6) 420 (31.6) 110 (8.3) 1329
Bangladesh 0.0 0.0 16 (11.4) 36 (25.7) 58 (41.4) 26 (18.8) 4 (2.86) 140
Saudi Arabia 23 (5.3) 21 (4.8) 87 (20.1) 99 (29.9) 84 (18.4) 119 (27.5) 433
South Africa -- 4649
Moracco 0.0 50 (6.03) 356 (43.0) 93 (11.2) 828
Thailand 0.0 0.0 25 (5.9) 70 (16.4) 101 (23.7) 118 (27.7) 81 (19.01) 31 (7.28) 426
Taiwan 8 (1.6) 105 (21.2) 294 (59.3) 89 (17.9) 496
China 22 (1.44) 20 (1.31) 164 (10.8) 281 (18.5) 399 (26.2) 413 (27.2) 171 (11.3) 46 (3.02) 1520
Germany -- 45,783
Argentina -- 300
Bulgaria -- 24,800
Russia -- 750
France -- 5782
Japan 1816
Africa 6 (4.5) 38 (28.8) 49 (37.1) 39 (29.5) 132
Turkey -- 6453
Ireland 149 (9.2) 964 (59.6) 505 (31.2) 1618
Korea 0.0 0.0 0.0 0.0 No exact data** 0.0 0.0 33,078
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*-- Not discussed in their study, **Most cases in this age group

In contrast, China[47] and Thailand[48] showed the highest prevalence in the 51–60 years of age group, 27.2% and 27.7%, respectively, closely followed by the 41–50 years of age group. In these areas, there is a gradual rise in the number of cases as age increases, which then decreases in older age groups. In Taiwan, the population is most prone to urinary stones between the ages of 41–70 years.[49] In Africa, the peak of the incidence was observed in the 41–60 years of age group (37.1%),[50] while in the United States, cases were observed from the age of 20 years onward.[51]

In the Korean population, most numbers of the patients were found in the 50–59 years of age group.[52] Countries such as South Africa,[53] Sri Lanka,[54] Germany,[55] Argentina,[56] Bulgaria,[57] Russia,[58] France,[59] Japan,[60] and Turkey[61] did not provide detailed age-specific data, but general trends suggest middle-aged groups as the most affected.

The variations in peak age groups across countries highlight the complex interplay of genetic, environmental, and lifestyle factors in urinary stone. Further research focusing on regional differences in risk factors is warranted to develop age-targeted preventive strategies [Table 4].

REGIONAL AND DEMOGRAPHIC VARIATIONS IN RISK FACTORS FOR URINARY STONE DISEASE

During the study of the impact of regional and demographic variations on urinary stone development, the gender distribution of urinary stone patients was analyzed across different countries which shows that males have a higher prevalence than females in almost all regions, with Thailand being an exception where both genders are nearly equal [Figure 5a].

Figure 5.

Figure 5

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(a) Urinary stone risk factor within male–female population in different regions of world, (b) risk factors contributing to urinary stone formation in certain regions include the impact of comorbidities and addictions

In regions such as Saudi Arabia, Taiwan, and China, a substantial proportion of patients presented with comorbidities, including diabetes and hypertension. This observation points to a possible association between metabolic conditions and urinary stone formation, underscoring the importance of systemic health in the pathophysiology of urinary stone.

Regarding addiction-related factors, alcohol consumption and smoking were documented exclusively in Taiwan, where 5.4% of cases reported alcohol use and 19.2% reported smoking. These behaviors may exacerbate dehydration and alter metabolic processes, contributing to stone formation [Figure 5b].

Dietary practices, such as vegetarian versus nonvegetarian preferences, were not comprehensively reported but represent a critical factor in understanding regional variations in urinary stone prevalence. In addition, data on water intake were sparse but remain essential for evaluating hydration status as a key determinant of urinary stone disease.

ANALYSIS OF THE GLOBAL TREND OF URINARY STONE COMPOSITION

CaOx stones are consistently the most common type across regions, with high prevalence rates in Bulgaria (86.0%), Argentina (80%), the United States (79.2%), South Africa (78.2%), and China (77.5%). These findings align with global trend, as CaOx is the most frequently reported stone composition, often associated with dietary factors and hydration levels.

UA stones are predominantly found in countries such as the USA, Pakistan, France, Saudi Arabia, and Russia due to a combination of dietary, lifestyle, and metabolic factors. In the USA (14.3%), high consumption of purine-rich foods, obesity, and metabolic syndrome contribute to stone formation. In Pakistan (13.5%) and Saudi Arabia (12.8%), protein-rich foods and inadequate hydration due to arid climates play a significant role. France (13.01%) and Russia (10.8%) show similar trends, influenced by dietary habits, cold climates reducing water intake, and metabolic disorders. These factors underscore the interplay of diet, hydration, and systemic health in UA stone prevalence across these regions.

The low prevalence of UA stones (2.5%) in India, compared to other countries, can be attributed to dietary and lifestyle factors. The predominantly vegetarian diet, low in purine-rich foods, reduces UA production. In addition, alkaline-forming foods, such as fruits and vegetables, maintain a higher urinary pH. Frequent hydration practices and cultural influences further reduce the risk of UA stone formation in the Indian population.

Co3Ap stones exhibit a higher prevalence in Sri Lanka (21%), France (13.9%), Morocco (11%), and Germany (10.2%) compared to India (6.0%). This variation may be influenced by regional differences in dietary calcium and phosphate intake, urine alkalinity, and water composition, as well as environmental and genetic factors.

Calcium hydrogen phosphate stones are relatively rare, with minimal representation in countries such as India (0.08%), Pakistan (2.3%), and Morocco (1.1%). Its low occurrence suggests that dietary and metabolic factors may limit this stone type’s formation in the general population. However, its notably higher prevalence in Russia (7.5%) warrants further investigations.

The markedly lower prevalence of struvite urinary stones in India (1.71%) compared to Ireland (13.7%), China (7.6%), and Morocco (7.0%) suggests significant regional differences in the etiological factors contributing to stone formation. These variations may be attributed to differences in the prevalence of UTIs, healthcare access and management, dietary patterns, and socioeconomic conditions. The low prevalence in India could also reflect differences in microbial profiles, sanitation practices, or underdiagnosis due to limited healthcare resources in certain areas.

CYS and XAN stones are rare across most countries; CYS and XAN stones are seen in trace amounts. CYS stones appear occasionally in India (2.3%) and Turkey (3.08%), while XAN stones appear rarely in some areas, likely due to genetic factors, as these are associated with metabolic disorders.

The high prevalence of mixed-composition urinary stones in regions such as Taiwan (52.3%), Japan (41.0%), Turkey (28%), Bangladesh (27.1%), and India (22.0%) underscore the complexity of stone formation in these populations. This phenomenon suggests the influence of diverse and overlapping etiological factors, including dietary habits, environmental conditions, genetic predisposition, and metabolic abnormalities. The relatively lower prevalence in India compared to Taiwan and Japan may reflect regional differences in these contributing factors, as well as variations in diagnostic and reporting practices.

This global overview of urinary stone composition provides insights into how regional environmental, dietary, and healthcare factors influence the types and prevalence of urinary stones worldwide [Figure 6].

Figure 6.

Figure 6

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Urinary stone composition comparison in different countries. CaOx: Calcium oxalate, Co3Ap: Carbonate apatite, MAP: Magnesium ammonium phosphate, AHU: Ammonium hydrogen urate, UA: Uric acid, CHP: Calcium hydrogen phosphate, CaPO4: Calcium orthophosphate, CYS: Cystine, XAN: Xanthine

DISCUSSION

Urinary stone formation in the urinary tract remains a prevalent condition worldwide, with significant regional variations in prevalence, composition, and associated risk factors. This review explored the diversity in clinical characteristics and stone composition in different regions of India, juxtaposed with global trends, to provide a comprehensive understanding of urinary stone composition and their management.

The analysis reveals that CaOx stones are the predominant type across India, consistent with global trends. However, notable regional variations exist, influenced by dietary, environmental, and sociocultural factors. For instance, the high prevalence of CaOx stones in northern India is attributed to diets rich in oxalate-containing foods such as spinach and tomatoes, combined with low fluid intake due to arid climates.[28,30] In contrast, the high prevalence of CaOx stones in European countries is primarily attributed to diet rich in animal protein and oxalate-containing foods.[10] Meanwhile, regions such as Kerala and Tamil Nadu report higher incidences of UA stones, likely due to dietary habits involving high-protein consumption and a predisposition to metabolic conditions such as diabetes and obesity.[35,38]

Mixed stones, made up of multiple minerals, are more prevalent in certain areas such as Rajasthan and Mangalore, reflecting complex etiological factors.[43,44] The occurrence of struvite stones, typically associated with UTIs, has declined globally due to improved infection management but remains significant in regions with limited healthcare access.[17] These findings underscore the critical role of region-specific dietary habits, environmental conditions, and healthcare infrastructure in shaping the epidemiology of urinary stones.

Globally, the prevalence of CaOx stones is ubiquitous, reflecting common dietary and hydration patterns.[10,15] However, regional differences in other stone types, such as Co3Ap and struvite, underscore the impact of healthcare quality and sanitation. For instance, higher rates of struvite stones in some regions of Africa and Asia are linked to increased UTIs, while UA stones are more prevalent in warmer climates due to dehydration.[46,49]

Recent epidemiological data from 2021 to 2024 reveal striking patterns in the global distribution of urinary stones. In 2021 alone, the global burden reached 106 million incident cases, with men accounting for 67% of cases.[62] While regional variations persist, prevalence rates range from 1% to 5% in most Asian countries, 5%–9% in Europe, and 7%–15% in western nations. India presents a unique case with a notably high prevalence of approximately 12%.[63] Metabolic evaluations have revealed distinct patterns between Indian and western populations; while hypercalciuria remains a significant factor in both regions, Indian patients exhibit different prevalence rates of metabolic risk factors compared to their western counterparts.[64] These variations underscore the importance of region-specific approaches to prevention and treatment strategies.

Interestingly, some regions in India report a high prevalence of urinary stones despite seemingly adequate water intake. This paradox may be explained by factors such as mineral-rich groundwater, high climatic temperatures leading to increased water loss, and genetic predispositions.[27,30] These findings emphasize the need for targeted public health interventions, including promoting hydration with low-mineral water and addressing occupational exposures.

Recent advancements in diagnostic and therapeutic approaches have greatly improved urinary stone management. Techniques such as Fourier transform infrared spectroscopy and X-ray diffraction provide detailed stone composition insights, while metabolic evaluations help identify underlying abnormalities, enabling personalized treatment and targeted prevention strategies.[37,45]

Minimally invasive surgical techniques, such as ureteroscopy and percutaneous nephrolithotomy, have reduced the morbidity associated with stone removal. Furthermore, advancements in lithotripsy technologies have enhanced the efficacy of noninvasive treatments.[14] However, access to these technologies remains uneven across regions, necessitating efforts to bridge healthcare disparities.

Given the high recurrence rates of urinary stone, preventive strategies should be prioritized. Promoting adequate hydration, particularly in arid regions, and educating populations on reducing dietary oxalates and sodium are critical measures.[26] In addition, encouraging dietary diversification to include more fruits and vegetables while moderating animal protein intake can mitigate risk factors.

For regions with a high burden of infection-related stones, improving sanitation and ensuring timely treatment of UTIs are essential. Public health campaigns should also address occupational risks, such as prolonged exposure to high temperatures, which exacerbate dehydration.[32]

Future research should focus on unraveling the genetic and molecular mechanisms underlying stone formation. Studies exploring the role of the microbiome in urinary stones and the impact of climate change on hydration patterns and dietary habits could provide novel insights.[16] Furthermore, large-scale, multicentric studies are needed to validate regional findings and develop evidence-based guidelines tailored to diverse populations.

CONCLUSION

Despite advancements in diagnosis and treatment, urinary stones continue to impose a significant health burden globally. This review highlights the importance of understanding regional variations in stone composition and risk factors to develop targeted prevention and management strategies, such as increased water intake, dietary modifications, and regular monitoring of high-risk individuals, which can significantly reduce stone recurrence rates. Integrating these approaches into public health policies is crucial. Future studies should focus on the interplay of genetic, dietary, and environmental factors to develop region-specific management protocols for urinary stones.

Conflicts of interest

There are no conflicts of interest.

Funding Statement

Nil.

REFERENCES

  • 1.Moe OW. Kidney stones: Pathophysiology and medical management. Lancet. 2006;367:333–44. doi: 10.1016/S0140-6736(06)68071-9. [DOI] [PubMed] [Google Scholar]
  • 2.Pearle MS, Calhoun EA, Curhan GC. Bethesda, MD: National Institutes of Health (NIH);NIH Publication; 2007. Urologic Diseases in America; pp. 283–319. No. 07–5512. [Google Scholar]
  • 3.Chauhan CK, Joshi MJ, Vaidya AD. Growth inhibition of struvite crystals in the presence of herbal extract Boerhaavia diffusa Linn. Am J Infect Dis. 2009;5:177–86. doi: 10.1007/s10856-008-3489-z. [DOI] [PubMed] [Google Scholar]
  • 4.López M, Hoppe B. History, epidemiology and regional diversities of urolithiasis. Pediatr Nephrol. 2010;25:49–59. doi: 10.1007/s00467-008-0960-5. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 5.Sequira L, Hebbar S, Ravishanker N. Prevalence and associated risk factors of urinary stone in India, a systematic review. Biomedicine. 2023;43:572–6. [Google Scholar]
  • 6.Al-Qaralleh AA, Abdeldayem MA, Kawaldeh BA. Type 2 diabetes mellitus and the risk of uric acid stone formation. J R Med Serv. 2021;28:38–43. [Google Scholar]
  • 7.Wan C, Xiang J, Yang B, Xu J, Geng E, Yang Y, et al. Current status of component analysis of urinary calculi. J Urol Ren Dis. 2024;9:1383. [Google Scholar]
  • 8.Alelign T, Petros B. Kidney stone disease: An update on current concepts. Adv Urol 2018. 2018:1–12. doi: 10.1155/2018/3068365. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 9.Preminger GM, Tiselius HG, Assimos DG, Alken P, Buck C, Gallucci M, et al. 2007 guideline for the management of ureteral calculi. J Urol. 2007;178:2418–34. doi: 10.1016/j.juro.2007.09.107. [DOI] [PubMed] [Google Scholar]
  • 10.Coe FL, Evan A, Worcester E. Kidney stone disease. J Clin Invest. 2005;115:2598–608. doi: 10.1172/JCI26662. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 11.Chaudhary A, Singla SK, Tandon C. In vitro evaluation of Terminalia arjuna on calcium phosphate and calcium oxalate crystallization. Indian J Pharm Sci. 2010;72:340–5. doi: 10.4103/0250-474X.70480. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 12.Bensatal A, Ouahrani MR. Inhibition of crystallization of calcium oxalate by the extraction of Tamarix gallica L. Urol Res. 2008;36:283–7. doi: 10.1007/s00240-008-0157-1. [DOI] [PubMed] [Google Scholar]
  • 13.Dal Moro F, Mancini M, Tavolini IM, De Marco V, Bassi P. Cellular and molecular gateways to urolithiasis: A new insight. Urol Int. 2005;74:193–7. doi: 10.1159/000083547. [DOI] [PubMed] [Google Scholar]
  • 14.Kishore DV, Moosavi F, Varma DR. Effect of ethanolic extract of Portulaca oleracea Linn. On ethylene glycol and ammonium chloride induced urinary stone. Int J Pharm Pharm Sci. 2013;5:134–40. [Google Scholar]
  • 15.Kumar SB, Kumar KG, Srinivasa V, Bilal S. A review on urinary stone. Int J Univ Pharm Life Sci. 2012;2:269–80. [Google Scholar]
  • 16.Giannossi ML, Summa V. A review of pathological biomineral analysis techniques and classification schemes. In: Aydinalp C, editor. An introduction to the study of mineralogy. Rijeka, Croatia: InTechOpen; 2012. [[Last accessed on 2025 Jan 02]]. pp. 123–46. Available from: https://www.intechopen.com/books/ [Google Scholar]
  • 17.Griffith DP. Struvite stones. Kidney Int. 1978;13:372–82. doi: 10.1038/ki.1978.55. [DOI] [PubMed] [Google Scholar]
  • 18.Ngo TC, Assimos DG. Uric acid nephrolithiasis: Recent progress and future directions. Rev Urol. 2007;9:17–27. [PMC free article] [PubMed] [Google Scholar]
  • 19.Carpenter TO, Lebowitz RL, Nelson D, Bauer S. Hereditary xanthinuria presenting in infancy with nephrolithiasis. J Pediatr. 1986;109:307–9. doi: 10.1016/s0022-3476(86)80391-2. [DOI] [PubMed] [Google Scholar]
  • 20.Mateos FA, Puig JG, Jiménez ML, Fox IH. Hereditary xanthinuria. Evidence for enhanced hypoxanthine salvage. J Clin Invest. 1987;79:847–52. doi: 10.1172/JCI112893. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 21.Kumar P, Ahmad S, Prem P, Mazumdar H, Kiran KA, Singh S. Decoding urinary stones: Compositional insights and recurrence patterns from a tertiary care hospital in Eastern India. Cureus. 2024;16:e70136. doi: 10.7759/cureus.70136. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 22.Aggarwal KP, Narula S, Kakkar M, Tandon C. Nephrolithiasis: Molecular mechanism of renal stone formation and the critical role played by modulators. Biomed Res Int 2013. 2013:292953. doi: 10.1155/2013/292953. [DOI] [PMC free article] [PubMed] [Google Scholar] [Retracted]
  • 23.Chhiber N, Sharma M, Kaur T, Singla S. Mineralization in health and mechanism of kidney stone formation. Int J Pharm Sci Invent. 2014;3:25–31. [Google Scholar]
  • 24.Kumar R, Kapoor R, Mittal B, Kumar A, Mittal RD. Evaluation of urinary abnormalities in urolithiasis patients: A study from North India. Indian J Clin Biochem. 2003;18:209–15. doi: 10.1007/BF02867389. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 25.Ansari MS, Gupta NP, Hemal AK, Dogra PN, Seth A, Aron M, et al. Spectrum of stone composition: Structural analysis of 1050 upper urinary tract calculi from Northern India. Int J Urol. 2005;12:12–6. doi: 10.1111/j.1442-2042.2004.00990.x. [DOI] [PubMed] [Google Scholar]
  • 26.Nerli RB, Patil S, Hiremath MB, Patil RA. Renal stone disease in the border regions of Karnataka, Maharashtra, and Goa: Role of diet, urinary pH, and body mass index. Indian J Health Sci Biomed Res. 2014;7:83–7. [Google Scholar]
  • 27.Mitra P, Pal DK, Das M. Does quality of drinking water matter in kidney stone disease: A study in West Bengal, India. Investig Clin Urol. 2018;59:158–65. doi: 10.4111/icu.2018.59.3.158. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 28.Sharma SK, Samal IR, Soumya NP. Urinary stones in Southern India: Biochemical analysis and its clinical implications. Int J Gen Med Pharm. 2015;4:93–100. [Google Scholar]
  • 29.Rao TVRK, Bano S, Das M. Epidemiology of urinary stone and chemical composition of urinary stones in Purnia Division of Bihar. Indian J Community Med. 2006;31:76–7. [Google Scholar]
  • 30.Dongre AR, Rajalakshmi M, Deshmukh PR, Thirunavukarasu MR, Kumar R. Risk factors for kidney stones in rural Puducherry: Case-control study. J Clin Diagn Res. 2017;11:C01–5. doi: 10.7860/JCDR/2017/29465.10561. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 31.Manzoor MA, Mujeeburahiman M, Rekha PD. Association of serum biochemical panel with mineralogical composition of kidney stone in India. Acta Med Int. 2017;4:26–30. [Google Scholar]
  • 32.Prakash R, Arunachalam A, Narayanasamy N. Prevalence and socio-demographic status of kidney stone patients in Thanjavur District, Tamil Nadu, India. Int J Community Med Public Health. 2019;6:1943–7. [Google Scholar]
  • 33.Kakkar M, Kakkar R. A 13 year hospital based study on the trend of urinary stone disease in Uttarakhand, India. Nepal J Epidemiol. 2021;11:949–58. doi: 10.3126/nje.v11i1.35896. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 34.Bhattacharyya S, Sharma G, Mandal AK, Singh SK. Analysis of the chemical composition of urinary calculi using Fourier Transform Infrared Spectroscopy: a preliminary study. J Postgrad Med Educ Res. 2014;48:128–31. [doi: 10.5005/jp-journals-10028-1117] [Google Scholar]
  • 35.Madhusudan A, Arif M, Hebbar AK, Karthavya SL. Epidemiology and chemical composition of upper urinary tract calculi. SAS J Med. 2015;1:1–6. [Google Scholar]
  • 36.Sofia NH, Walter TM, Sanatorium T. Prevalence and risk factors of kidney stone. Glob J Res Anal. 2016;5:183–7. [Google Scholar]
  • 37.Faridi MS, Singh KS. Preliminary study of prevalence of urolithiasis in North-Eastern city of India. J Family Med Prim Care. 2020;9:5939–43. doi: 10.4103/jfmpc.jfmpc_1522_20. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 38.Lohiya A, Kant S, Kapil A, Gupta SK, Misra P, Rai SK. Population-based estimate of urinary stones from Ballabgarh, Northern India. Natl Med J India. 2017;30:198–200. doi: 10.4103/0970-258X.218671. [DOI] [PubMed] [Google Scholar]
  • 39.Bhat A, Singh V, Bhat M, Kumar V, Bhat A. Spectrum of urinary stone composition in Northwestern Rajasthan using Fourier transform infrared spectroscopy. Indian J Urol. 2018;34:144–8. doi: 10.4103/iju.IJU_363_16. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 40.Sunitha J, Thirunavukkarasu P, Asha S. A retrospective study on prevalence and risk factors associated with kidney stone in Vellore District, Tamil Nadu. Int J Pharm Sci Rev Res. 2018;48:54–7. [Google Scholar]
  • 41.Bhattacharya S, Joshi NK, Jain YK, Bajpai N, Bhardwaj P, Chaturvedi M, et al. Dietary determinants of renal calculi: A case-control study from a tertiary care hospital of Western Rajasthan. Cureus. 2022;14:e31460. doi: 10.7759/cureus.31460. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 42.Bibi A, Aamir M, Riaz M, Haroon ZH, Kirmani SI, Javaid H. Assessment of frequency and composition of renal stones in a reference laboratory of Pakistan. Pak Armed Forces Med J. 2023;73:341–4. [Google Scholar]
  • 43.Das Gupta S, Mahbub MU, Ghani A, Rahman MM, Haque MZ. Chemical composition of urinary tract stones: experience in a medical college hospital in Dhaka. Bangladesh J Urol. 2015;18:8–11. [Google Scholar]
  • 44.Al-Nasser KA, Neel AF, Alyami FA, Al-Barraq KM, Alsheheli MM, Alomar MA, et al. Demographic variability of urinary tract stones in Saudi Arabia. J Urol Nephrol. 2020;5:1–7. [Google Scholar]
  • 45.Habbani RE, Kachkoul R, Chaqroune A, Lahrichi A, Mohim M, Oumari FE, et al. The relationship between the stone's composition and the biochemical parameters of blood and urine in patients with urinary stone. Sci Afr. 2023;19:1–7. [Google Scholar]
  • 46.Tyson M, Grimes N, McAuley L, Hennessy D, Pahuja A, Young M. Renal and ureteric stone composition: A five year retrospective study for Northern Ireland. Ulster Med J. 2019;88:21–4. [PMC free article] [PubMed] [Google Scholar]
  • 47.Zhang D, Li S, Zhang Z, Li N, Yuan X, Jia Z, et al. Urinary stone composition analysis and clinical characterization of 1520 patients in central China. Sci Rep. 2021;11:6467. doi: 10.1038/s41598-021-85723-3. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 48.Prasongwatana V, Bovornpadungkitti S, Chotikawanich E, Pachitrat K, Suwanatrai S, Sriboonlue P. Chemical components of urinary stones according to age and sex of adult patients. J Med Assoc Thai. 2008;91:1589–94. [PubMed] [Google Scholar]
  • 49.Chou YH, Li CC, Wu WJ, Juan YS, Huang SP, Lee YC, et al. Urinary stone analysis of 1,000 patients in Southern Taiwan. Kaohsiung J Med Sci. 2007;23:63–6. doi: 10.1016/S1607-551X(09)70376-6. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 50.Diangienda PK, Moningo DM. Morpho-constitutional analysis of urinary stones from patients with urinary stone in the democratic republic of Congo. Afr J Urol. 2021;27:99. [Google Scholar]
  • 51.Katz JE, Soodana-Prakash N, Jain A, Parmar M, Smith N, Kryvenko O, et al. Influence of age and geography on chemical composition of 98043 urinary stones from the USA. Eur Urol Open Sci. 2021;34:19–26. doi: 10.1016/j.euros.2021.09.011. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 52.Jung HD, Seo IY, Lee JY. Large database study of urinary stone composition in South Korea: Korean Society of Endourology and Robotics (KSER) research series. Investig Clin Urol. 2021;62:462–9. doi: 10.4111/icu.20210039. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 53.Kerr A, Laing M. Review of human renal stone analysis, with emphasis on results from the Durban area, South Africa. Appl Geochem. 1993;8:245–53. [Google Scholar]
  • 54.Chandrajith R, Weerasingha A, Premaratne KM, Gamage D, Abeygunasekera AM, Joachimski MM, et al. Mineralogical, compositional and isotope characterization of human kidney stones (urolithiasis) in a Sri Lankan population. Environ Geochem Health. 2019;41:1881–94. doi: 10.1007/s10653-018-0237-2. [DOI] [PubMed] [Google Scholar]
  • 55.Siener R, Herwig H, Rüdy J, Schaefer RM, Lossin P, Hesse A. Urinary stone composition in Germany: Results from 45,783 stone analyses. World J Urol. 2022;40:1813–20. doi: 10.1007/s00345-022-04060-w. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 56.Halinski A, Bhatti KH, Boeri L, Cloutier J, Davidoff K, Elqady A, et al. Stone composition of renal stone formers from different global regions. Arch Ital Urol Androl. 2021;93:307–12. doi: 10.4081/aiua.2021.3.307. [DOI] [PubMed] [Google Scholar]
  • 57.Atanassova SS, Panchev PK. Kidney stones in a southeast European population from Bulgaria. Clin Chem Lab Med. 2013;51:e227–9. doi: 10.1515/cclm-2013-0217. [DOI] [PubMed] [Google Scholar]
  • 58.Novikov A, Nazarov T, Startsev VY. Epidemiology of stone disease in the Russian Federation and post-Soviet era. In: Talati J, Tiselius HG, Albala D, Ye Z, editors. Urinary Stone. London: Springer; 2012. [Google Scholar]
  • 59.Roger C, Abid N, Dubourg L, Auvergnon C, Lemoine S, Machon C. Composition of urinary calculi: Lessons from a French epidemiologic retrospective study. Prog Urol. 2020;30:339–45. doi: 10.1016/j.purol.2020.03.003. [DOI] [PubMed] [Google Scholar]
  • 60.Hossain RZ, Ogawa Y, Hokama S, Morozumi M, Hatano T. Urolithiasis in Okinawa, Japan: A relatively high prevalence of uric acid stones. Int J Urol. 2003;10:411–5. doi: 10.1046/j.1442-2042.2003.00656.x. [DOI] [PubMed] [Google Scholar]
  • 61.Karabacak OR, Dilli A, Saltaş H, Yalçınkaya F, Yörükoğlu A, Sertçelik MN. Stone compositions in Turkey: An analysis according to gender and region. Urology. 2013;82:532–7. doi: 10.1016/j.urology.2013.04.059. [DOI] [PubMed] [Google Scholar]
  • 62.Awedew AF, Han H, Berice BN, Dodge M, Schneider RD, Kangevari MA, et al. The global, regional, and national burden of urolithiasis in 204 countries and territories, 2000–2021: a systematic analysis for the Global Burden of Disease Study 2021. eClinicalMedicine. 2023;78:102924. doi: 10.1016/j.eclinm.2024.102924. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 63.Moftakhar L, Jafari F, Ghoddusi Johari M, Rezaeianzadeh R, Hosseini SV, Rezaianzadeh A. Prevalence and risk factors of kidney stone disease in population aged 40-70 years old in Kharameh cohort study: A cross-sectional population-based study in southern Iran. BMC Urol. 2022;22:205. doi: 10.1186/s12894-022-01161-x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 64.Julka S, Gupta SK, Srivastava A. Protocol-based metabolic evaluation in high-risk patients with renal stones in North India. Indian J Endocrinol Metab. 2012;16:283–7. doi: 10.4103/2230-8210.93754. [DOI] [PMC free article] [PubMed] [Google Scholar]

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