Stesura Seveso 217Archivio Italiano di Urologia e Andrologia 2014; 86, 3 SHORT COMMUNICATION Comparison of individuals consuming natural spring water and tap water in terms of urinary tract stone disease Mustafa Resorlu 1, Muhammet Arslan 2, Eylem Burcu Resorlu 3, Murat Tolga Gulpinar 4, Gurhan Adam 1, Eyup Burak Sancak 4, Alpaslan Akbas 4, Nilufer Aylanc 1, Huseyin Ozdemir 1 1 Department of Radiology, Canakkale Onsekiz Mart University, Faculty of Medicine, Canakkale, Turkey; 2 Department of Radiology, Vefa Hospital, Manisa, Turkey; 3 Department of Radiology, Canakkale State Hospital, Canakkale, Turkey; 4 Department of Urology, Canakkale Onsekiz Mart University, Faculty of Medicine, Canakkale, Turkey. Objectives: To compare individuals con- suming natural spring water and tap water in terms of presence of urinary tract stone disease. Patients and methods: Patients were divided into two groups on the basis of the type of water: tap water (Group I) vs natural spring water consumers (Group II). The two groups were compared in terms of presence of urolithiasis. In addition to the type of water consumed, participants were investigated in terms of age, sex, occupation, body mass index (BMI) and presence of hypertension (HT) and diabetes mellitus in order to evaluate if they constituted a risk factor for urolithiasis. Results: Two hundred fifty-nine patients consuming tap water and 254 consuming natural spring water were included in this study. Presence of urinary stone disease was determined in 27% of patients in Group I and 26% of Group II (p = 0.794). At multivariate analysis involving all variables that might be correlated with the presence of urolithiasis; male gender, high BMI and presence of HT emerged as being significantly associated with urolithiasis. Conclusions: Although we showed that male gender, pres- ence of HT and high BMI affect stone formation, no differ- ence was demonstated in terms of presence of stone among patients consuming tap or natural spring water KEY WORDS: Tap water; Natural spring water; Ultrasound; Urolithiasis. Submitted 3 July 2014; Accepted 14 July 2014 Summary No conflict of interest declared. INTRODUCTION Urinary system stone disease is a common pathology, with a lifetime prevalence across the world of between 1% and 15% (1). The disease is more common in some geographical regions probably in relation with various genetic and environmental factors. Considering environ- mental factors alone, stone disease is more common in mountaineous areas and in people living in dry and hot climatic conditions, such as deserts and tropical re - gions (2). Studies have implicated temperature-related fluid loss from the body and rise in vitamin D stimulat- ed by solar rays as the main reasons for this (3,4). DOI: 10.4081/aiua.2014.3.217 Several studies have proved that increasing daily fluid intake plays a protective role against stone formation by leading to diuresis and preventing supersaturation of stone components in urine (5-7). As much as the amount of fluid consumed, however, several studies have also considered the effect on stone formation of mineral content, electrolyte level, hardness and pH level of water consumed (8-15). However, no studies to date have investigated the wide- spread popular idea that consumption of chlorinated tap water can lead to stone disease. In order to answer that question, we used renal ultrasound (US) to compare indi- viduals consuming natural spring water or tap water in terms of presence of stone in the urinary system. MATERIALS AND METHODS Study population Five hundred thirteen patients aged over 18 who under- went urinary system US due to abdominal or flank pain and meet study conditions were included in the study fol- lowing approval of its design by the Çanakkale Onsekiz Mart University Ethical Committee. Subjects with renal mal- formation that might constitute a risk factor for urinary stone formation (horseshoe kidney, polycystic renal dis- ease, malrotated or ectopic kidney, ureteropelvic junction obstruction etc.), with known glomerular or tubular renal disease or a family predisposition (with stone first detected in childhood) to stone disease were excluded from the study. Patients were divided into two groups on the basis of the type of water they had principally consumed in the pre- vious 2 years: those consuming tap water (Group I) and those consuming natural spring water (Group II). Patients drinking both types of water or had changed the type of Low Urin e Volume Urine Supersat uration High Uri ne Concent ration Crystal Aggregat ion High Fluid Intake Tiselius oxalate-calcium crystallization risk index: 1.9 x (Ca)0.84 x (Ox) x (Mg)-0.12 x (Cit)-0.22 x Urine Volume-1.03 Stone Formatio n Resorlu SC_Stesura Seveso 08/10/14 12:15 Pagina 217 Archivio Italiano di Urologia e Andrologia 2014; 86, 3 M. Resorlu, M. Arslan, E. Burcu Resorlu, M. Tolga Gulpinar, G. Adam, E. Burak Sancak, A. Akbas, N. Aylanc, H. Ozdemir 218 water consumed over the preceding 2 years or stating to consumed less than 7 glasses of water a day (< 1.5 L/day) were excluded. In addition to the type of water consumed, demographic data such as participants’ age, sex, occupa- tion, body mass index (BMI) and presence of chronic dis- eases such as hypertension (HT) and diabetes mellitus (DM) were recorded. All these variables were investigated in terms of whether or not they constituted a risk factor for presence of stone in the urinary system. Ultrasound measurements All examinations were performed by radiologists with experience of ultrasound. Sonographic examinations were performed with gray scale ultrasound machines (Toshiba Aplio XG and General Electric Logiq 9) using two convex transducers with 3.5 MHz, 4.0 MHz frequency. The presence of the stone was defined as presence of an echogenic image with or without posterior acoustic shadowing, clearly located within the urinary tract. Statistical analysis All statistical analyses were performed using SPSS, ver- sion 16.0. All values are shown as mean ± standard devi- ation. Comparisons were performed using the chi-square test. Differences between groups were considered statis- tically significant at p < 0.05. RESULTS Two hundred fifty-nine patients consuming tap water (Group I) and 254 consuming natural spring water (Group II) were included in the study. In terms of gender, 52% of males stated that they used to drink tap water and 48% natural spring water, while 49% of women used to drink tap water and 51% natural spring water. Mean age of patients was 52.2 (18-88) years in group I and 48.6 (18- 86) in Group II (p = 0.75). Mean BMI values were 25.7 kg/m2 in Group I and 26.2 kg/m2 in Group II (p = 0.58). In terms of chronic diseases, HT was determined in 22% and DM in 17% of patients in group I, and in 16% and 12%, respectively, of those in Group II. Stone was detected in 26% (n = 145) of the patients in the study, in 33% of men and 18% of women (p < 0.001). Presence of stone in the urinary system was determined in 27% of patients in Group I and 26% of Group II (p = 0.794). Mean BMI of the patients with stone in the urinary system was 27.2 kg/m2 whereas it was 25.5 kg/m2 in those with no stone. DM was observed in 17% and HT in 31% of the patients with stone and in 14% and 15%, respectively, in those with no stone. At multivariate analysis involving all variables that might be correlated with the presence of a stone in the urinary sys- tem, male gender and presence of HT emerged as being sig- nificantly associated with urolithiasis. Variables such as age, occupation, type of water consumed and presence of DM were not risk factors for development of stone. CONCLUSIONS In this study we therefore investigated whether there is any association between consumption of tap or natural spring water and urolithiasis in patients receiving US due to abdominal or flank pain. 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Correspondence Mustafa Resorlu, MD (Corresponding Author) mustafaresorlu77@gmail.com Gurhan Adam, MD - Huseyin Ozdemir, MD - Nilufer Aylanc, MD Department of Radiology, Canakkale Onsekiz Mart University, Faculty of Medicine, Canakkale Onsekiz Mart Universitesi, Terzioglu Yerleskesi - Barbaros Mh, 17100, Canakkale, Turkey Muhammet Arslan, MD Department of Radiology, Vefa Hospital, Manisa, Turkey Eylem Burcu Resorlu, MD Department of Radiology, Canakkale State Hospital, Canakkale, Turkey Murat Tolga Gulpinar, MD - Eyup Burak Sancak, MD - Alpaslan Akbas, MD Department of Urology, Canakkale Onsekiz Mart University, Faculty of Medicine, Canakkale, Turkey Resorlu SC_Stesura Seveso 08/10/14 12:15 Pagina 218