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Filler, Guido; Dave, Sumit; Ritter, Victor; Ross, Sherry; Viprakasit, Davis; Hatch, Joseph E.; Bjazevic, Jennifer; Burton, Jeremy; Gilleskie, Donna B.; & Gilliland, Jason, et al. (2023). In Focus: Perplexing Increase of Urinary Stone Disease in Children, Adolescent and Young Adult Women and Its Economic Impact. Frontiers in Medicine, 10, 1272900. PMCID: PMC10626457


BACKGROUND: Urinary stone disease (USD) historically has affected older men, but studies suggest recent increases in women, leading to a near identical sex incidence ratio. USD incidence has doubled every 10 years, with disproportionate increases amongst children, adolescent, and young adult (AYA) women. USD stone composition in women is frequently apatite (calcium phosphate), which forms in a higher urine pH, low urinary citrate, and an abundance of urinary uric acid, while men produce more calcium oxalate stones. The reasons for this epidemiological trend are unknown.
METHODS: This perspective presents the extent of USD with data from a Canadian Province and a North American institution, explanations for these findings and offers potential solutions to decrease this trend. We describe the economic impact of USD.
FINDINGS: There was a significant increase of 46% in overall surgical interventions for USD in Ontario. The incidence rose from 47.0/100,000 in 2002 to 68.7/100,000 population in 2016. In a single United States institution, the overall USD annual unique patient count rose from 10,612 to 17,706 from 2015 to 2019, and the proportion of women with USD was much higher than expected. In the 10-17-year-old patients, 50.1% were girls; with 57.5% in the 18-34 age group and 53.6% in the 35-44 age group. The roles of obesity, diet, hormones, environmental factors, infections, and antibiotics, as well as the economic impact, are discussed.
INTERPRETATION: We confirm the significant increase in USD among women. We offer potential explanations for this sex disparity, including microbiological and pathophysiological aspects. We also outline innovative solutions - that may require steps beyond typical preventive and treatment recommendations.


Reference Type

Journal Article

Year Published


Journal Title

Frontiers in Medicine


Filler, Guido
Dave, Sumit
Ritter, Victor
Ross, Sherry
Viprakasit, Davis
Hatch, Joseph E.
Bjazevic, Jennifer
Burton, Jeremy
Gilleskie, Donna B.
Gilliland, Jason
Lin, Feng-Chang
Jain, Nina
McClure, Andrew
Razvi, Hassan
Bhayana, Vipin
Wang, Peter
Coulson, Sherry
Sultan, Nabil
Denstedt, John
Fearrington, Loretta
Diaz-Gonzalez de Ferris, Maria E.

Article Type





United States


North Carolina


Gilleskie - 0000-0002-1278-7707