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January 6, 1940


JAMA. 1940;114(1):6-12. doi:10.1001/jama.1940.02810010008002

No method has yet been developed to anticipate and prevent the formation of a ureteral calculus. Despite the present knowledge of the chemistry of urinary excretion and of methods of preventing the reformation of stones, the urologist is still keenly cognizant of the lack of positive and practical data pertaining to their causation. The importance of frequent contributions to the problem of causation is apparent, for as a result of these the solution may suddenly appear and only in its simplicity cause astonishment.

In recent years the most popular hypothesis of the causation of stone in the urinary tract includes hyperparathyroidism, vitamin deficiency, infection of the urinary tract by urea-splitting organisms, urinary stasis due to a variety of causes, and local disease involving the renal papillae. The validity of any of these being an etiologic factor in rare cases is indisputable but for the large majority of cases there is still no satisfactory explanation. The unknown factor remains to be found and the majority of urologists, while hoping for its discovery, will concern themselves in the meantime with what to do about a urinary calculus after it has formed.

In 1930 Bumpus and Thompson x reported a series of 1,001 cases of ureteral calculus. That article called attention to the importance of accurate diagnosis in order to avoid unnecessary operations, particularly