Skip to main content
Top
Published in: Urolithiasis 4/2020

01-08-2020 | Respiratory Microbiota | Original Paper

The relationship between calcium oxalate lithiasis and chronic proinflammatory intestinal dysbiosis pattern: a prospective study

Authors: Félix Millán Rodríguez, Laia Sabiote Rubio, Irene Girón Nanne, Francisco Sánchez Martín, Esteban Emiliani, Oriol Angerri Feu

Published in: Urolithiasis | Issue 4/2020

Login to get access

Abstract

The objective is to establish whether a pattern of intestinal dysbiosis exists in calcium oxalate (CaOx) lithiasis and, if so, to identify its characteristics and explore whether there are differences in the pattern between CaOx dihydrate (COD) and monohydrate (COM) lithiasis. With this aim 24 patients diagnosed with CaOx lithiasis by means of optical microscopy and spectrometry were prospectively recruited. Faecal analysis was carried out by means of RT-PCR 16S rRNA assay and agar plate culture according to the methodology proposed by the Institute of Microecology (Herborn, Germany). The total number of bacteria was depleted due to COD lithiasis (p = 0.036). The mean values of immunoregulating microbiota were normal, but the percentage of normal values was lower in the COD group (30%) than in the COM group (69.2%) (p = 0.062). The total mean values of protective microbiota were normal in both groups. There was a large decrease in the mean values of the muconutritive microbiota Akkermansia muciniphila and Faecalibacterium prausnitzii, the most intense decline being observed in the COD group (p = 0.019). Levels of proteolytic microbiota were elevated in both groups, without differences between them. We conclude that patients with CaOx lithiasis have a chronic pro-inflammatory intestinal dysbiosis pattern characterised by a reduction in the total number of bacteria, a reduction in immunoregulating microbiota and a large reduction in muconutritive microbiota that is significantly more intense in COD lithiasis than in COM lithiasis.
Literature
1.
go back to reference Sánchez-Martín FM, Angerri O, Emiliani E et al (2017) Epidemiology of urolithiasis in Spain: review of published demographic data in the period 1977–2016. Arch Esp Urol 70:294–303PubMed Sánchez-Martín FM, Angerri O, Emiliani E et al (2017) Epidemiology of urolithiasis in Spain: review of published demographic data in the period 1977–2016. Arch Esp Urol 70:294–303PubMed
2.
go back to reference Millán F, Gracia S, Sánchez-Martín FM, Angerri O, Rousaud F, Villavicencio H (2010) A new approach to urinary stone analysis according to the combination of the components: experience with 7949 cases. Actas Urológicas Españolas (English Edition) 35:138–143 Millán F, Gracia S, Sánchez-Martín FM, Angerri O, Rousaud F, Villavicencio H (2010) A new approach to urinary stone analysis according to the combination of the components: experience with 7949 cases. Actas Urológicas Españolas (English Edition) 35:138–143
3.
go back to reference Allison MJ, Littlekide ET, James LF (1977) Changes in ruminal oxalate degradation rates associated with adaptation to oxalate ingestion. J Anim Sci 45:1173–1179PubMed Allison MJ, Littlekide ET, James LF (1977) Changes in ruminal oxalate degradation rates associated with adaptation to oxalate ingestion. J Anim Sci 45:1173–1179PubMed
4.
go back to reference Allison MJ, Cook HM (1981) Oxalate degradation by microbes of the large bowel of herbivores: the effect of dietary oxalate. Science 212:675–676PubMed Allison MJ, Cook HM (1981) Oxalate degradation by microbes of the large bowel of herbivores: the effect of dietary oxalate. Science 212:675–676PubMed
5.
go back to reference Cornick NA, Allison MJ (1996) Anabolic incorporation of oxalate by Oxalobacter formigenes. Appl Environ Microbiol 62:3011–3013PubMedPubMedCentral Cornick NA, Allison MJ (1996) Anabolic incorporation of oxalate by Oxalobacter formigenes. Appl Environ Microbiol 62:3011–3013PubMedPubMedCentral
6.
go back to reference Siener R, Bangen U, Sidhu H, Hönow R, von Unruh G, Hesse A (2013) The role of Oxalobacter formigens colonization in calcium oxalate stone disease. Kidney Int 83:1144–1149PubMed Siener R, Bangen U, Sidhu H, Hönow R, von Unruh G, Hesse A (2013) The role of Oxalobacter formigens colonization in calcium oxalate stone disease. Kidney Int 83:1144–1149PubMed
7.
go back to reference Jiang J, Knight J, Easter LH, Neiberg R, Holmes RP, Assimos DG (2011) Impact of dietary calcium and oxalate, and Oxalobacter formigens colonization on urinary oxalate excretion. J Urol 186:135–139PubMedPubMedCentral Jiang J, Knight J, Easter LH, Neiberg R, Holmes RP, Assimos DG (2011) Impact of dietary calcium and oxalate, and Oxalobacter formigens colonization on urinary oxalate excretion. J Urol 186:135–139PubMedPubMedCentral
8.
go back to reference Kaufman DW, Kelly JP, Curhan GC et al (2008) Oxalobacter formigenes may reduce the risk of calcium oxalate kidney stones. J Am Soc Nephrol 19:1197–1203PubMedPubMedCentral Kaufman DW, Kelly JP, Curhan GC et al (2008) Oxalobacter formigenes may reduce the risk of calcium oxalate kidney stones. J Am Soc Nephrol 19:1197–1203PubMedPubMedCentral
9.
go back to reference Kelly JP, Curhan GC, Cave DR, Anderson TE, Kaufman DW (2011) Factors related to colonization with Oxalobacter formigenes in US adults. J Endourol 25:673–679PubMedPubMedCentral Kelly JP, Curhan GC, Cave DR, Anderson TE, Kaufman DW (2011) Factors related to colonization with Oxalobacter formigenes in US adults. J Endourol 25:673–679PubMedPubMedCentral
10.
go back to reference Batislam E, Yilmaz E, Yuvanc E, Kisa O, Kisa U (2012) Quantitative analysis of colonization with real-time PCR to identify the role of Oxalobacter formigenes in calcium oxalate urolithiasis. Urol Res 40:455–460PubMed Batislam E, Yilmaz E, Yuvanc E, Kisa O, Kisa U (2012) Quantitative analysis of colonization with real-time PCR to identify the role of Oxalobacter formigenes in calcium oxalate urolithiasis. Urol Res 40:455–460PubMed
11.
go back to reference Mittal RD, Kumar R, Bid HK, Mittal B (2005) Effect of antibiotics on Oxalobacter formigenes colonization of human gastrointestinal tract. J Endourol 19:102–106PubMed Mittal RD, Kumar R, Bid HK, Mittal B (2005) Effect of antibiotics on Oxalobacter formigenes colonization of human gastrointestinal tract. J Endourol 19:102–106PubMed
12.
go back to reference Troxel SA, Sidhu H, Kaul P, Low RK (2003) Intestinal Oxalobacter formigenes colonization in calcium oxalate stone formers and its relation to urinary oxalate. J Endourol 17:173–176PubMed Troxel SA, Sidhu H, Kaul P, Low RK (2003) Intestinal Oxalobacter formigenes colonization in calcium oxalate stone formers and its relation to urinary oxalate. J Endourol 17:173–176PubMed
13.
go back to reference Kumar R, Ghoshal UC, Singh G, Mittal RD (2004) Infrequency of colonization with Oxalobacter formigenes in inflammatory bowel disease: possible role in renal stone formation. J Gastroenterol Hepatol 19:1403–1409PubMed Kumar R, Ghoshal UC, Singh G, Mittal RD (2004) Infrequency of colonization with Oxalobacter formigenes in inflammatory bowel disease: possible role in renal stone formation. J Gastroenterol Hepatol 19:1403–1409PubMed
14.
go back to reference Lindsjo M, Danielson BG, Fellstrom B, Lithell H, Ljunghall S (1989) Intestinal absorption of oxalate and calcium in patients with jejunoileal bypass. Scand J Urol Nephrol 23:283–289PubMed Lindsjo M, Danielson BG, Fellstrom B, Lithell H, Ljunghall S (1989) Intestinal absorption of oxalate and calcium in patients with jejunoileal bypass. Scand J Urol Nephrol 23:283–289PubMed
15.
go back to reference Allison MJ, Cook HM, Milne DB, Gallager S, Clayman RV (1986) Oxalate degradation by gastrointestinal bacteria from humans. J Nutr 116:455–460PubMed Allison MJ, Cook HM, Milne DB, Gallager S, Clayman RV (1986) Oxalate degradation by gastrointestinal bacteria from humans. J Nutr 116:455–460PubMed
16.
go back to reference Mogna L, Pane M, Nicola S, Raiteri E (2014) Screening of different probiotic strains for their in vitro ability to metabolise oxalates. Any prospective use in humans? J Clin Gastroenterol 48:91–95 Mogna L, Pane M, Nicola S, Raiteri E (2014) Screening of different probiotic strains for their in vitro ability to metabolise oxalates. Any prospective use in humans? J Clin Gastroenterol 48:91–95
17.
go back to reference Miller AW, Dearing D (2013) The metabolic and ecological interactions of oxalate-degrading bacteria in the Mammalian gut. Pathogens 2:636–652PubMedPubMedCentral Miller AW, Dearing D (2013) The metabolic and ecological interactions of oxalate-degrading bacteria in the Mammalian gut. Pathogens 2:636–652PubMedPubMedCentral
19.
go back to reference Klimesova K, Whittamore JM, Hatch M (2015) Bifidobacterium animalis subsp. Lactis decreases urinary oxalate excretion in a mouse model of primary hyperoxaluria. Urolithiasis 43:107–117PubMed Klimesova K, Whittamore JM, Hatch M (2015) Bifidobacterium animalis subsp. Lactis decreases urinary oxalate excretion in a mouse model of primary hyperoxaluria. Urolithiasis 43:107–117PubMed
20.
go back to reference Turroni S, Vitali B, Bendazzoli C et al (2007) Oxalate consumption by lactobacilli: evaluation of oxalyl-CoA decarboxylase and formyl-CoA transferase activity in Lactobacillus acidophilus. J Appl Microbiol 103:1600–1609PubMed Turroni S, Vitali B, Bendazzoli C et al (2007) Oxalate consumption by lactobacilli: evaluation of oxalyl-CoA decarboxylase and formyl-CoA transferase activity in Lactobacillus acidophilus. J Appl Microbiol 103:1600–1609PubMed
21.
go back to reference Stern JM, Moazami S, Qiu Y et al (2016) Evidence for a distinct gut microbiome in kidney stone formers compared to non-stone formers. Urolithiasis 44:299–407 Stern JM, Moazami S, Qiu Y et al (2016) Evidence for a distinct gut microbiome in kidney stone formers compared to non-stone formers. Urolithiasis 44:299–407
22.
go back to reference Sidhu H, Schmidt ME, Cornelius T et al (1999) Direct correlation between hyperoxaluria/oxalate stone disease and the absence of the gastrointestinal tract dwelling bacterium Oxalobacter formigenes: possible prevention by gut recolonization or enzyme replacement therapy. J Am Soc Nephrol 10:S334–S340PubMed Sidhu H, Schmidt ME, Cornelius T et al (1999) Direct correlation between hyperoxaluria/oxalate stone disease and the absence of the gastrointestinal tract dwelling bacterium Oxalobacter formigenes: possible prevention by gut recolonization or enzyme replacement therapy. J Am Soc Nephrol 10:S334–S340PubMed
23.
go back to reference Kharlamb V, Schelker J, Francois F, Jiang J, Holmes RP, Goldfarb DS (2011) Oral antibiotic treatment of Helycobacter pylori leads to persistently reduced intestinal colonization rates with Oxalobacter formigenes. J Endourol 25:1781–1785PubMedPubMedCentral Kharlamb V, Schelker J, Francois F, Jiang J, Holmes RP, Goldfarb DS (2011) Oral antibiotic treatment of Helycobacter pylori leads to persistently reduced intestinal colonization rates with Oxalobacter formigenes. J Endourol 25:1781–1785PubMedPubMedCentral
24.
go back to reference Sidhu H, Hoppe B, Hesse A et al (1998) Absence of Oxalobacter formigenes in cystic fibrosis patients: a risk factor for hyperoxaluria. Lancet 352:1026–1029PubMed Sidhu H, Hoppe B, Hesse A et al (1998) Absence of Oxalobacter formigenes in cystic fibrosis patients: a risk factor for hyperoxaluria. Lancet 352:1026–1029PubMed
25.
go back to reference Borghi L, Nouvenne A, Meschi T (2010) Probiotics and dietary manipulations in calcium oxalate nephrolithiasis: two sides of the same coin? Kidney Int 78:1063–1065PubMed Borghi L, Nouvenne A, Meschi T (2010) Probiotics and dietary manipulations in calcium oxalate nephrolithiasis: two sides of the same coin? Kidney Int 78:1063–1065PubMed
26.
go back to reference Lieske JC, Tremaine WJ, De Simone C et al (2010) Diet, but no oral probiotics, effectively reduces urinary oxalate excretion and calcium oxalate supersaturation. Kidney Int 78:1178–1185PubMedPubMedCentral Lieske JC, Tremaine WJ, De Simone C et al (2010) Diet, but no oral probiotics, effectively reduces urinary oxalate excretion and calcium oxalate supersaturation. Kidney Int 78:1178–1185PubMedPubMedCentral
27.
go back to reference Okombo J, Liebman M (2010) Probiotic-induced reduction of gastrointestinal oxalate absorption in healthy subjects. Urol Res 38:169–178PubMed Okombo J, Liebman M (2010) Probiotic-induced reduction of gastrointestinal oxalate absorption in healthy subjects. Urol Res 38:169–178PubMed
28.
go back to reference Ferraz R, Marques NC, Froeder L et al (2009) Effects of Lactobacillus casei and Bifidobacterium breve on urinary oxalate excretion in nephrolithiasis patients. Urol Res 37:95–100PubMed Ferraz R, Marques NC, Froeder L et al (2009) Effects of Lactobacillus casei and Bifidobacterium breve on urinary oxalate excretion in nephrolithiasis patients. Urol Res 37:95–100PubMed
29.
go back to reference Campieri C, Campieri M, Bertuzzi V et al (2001) Reduction of oxaluria after an oral course of lactic acid bacteria at high concentration. Kidney Int 60:1097–1105PubMed Campieri C, Campieri M, Bertuzzi V et al (2001) Reduction of oxaluria after an oral course of lactic acid bacteria at high concentration. Kidney Int 60:1097–1105PubMed
30.
go back to reference Lieske JC, Goldfarb DS, De Simone C, Regnier C (2005) Use of a probiotic to decrease enteric hyperoxaluria. Kidney Int 68:1244–1249PubMed Lieske JC, Goldfarb DS, De Simone C, Regnier C (2005) Use of a probiotic to decrease enteric hyperoxaluria. Kidney Int 68:1244–1249PubMed
31.
go back to reference Goldfarb DS, Modersitzki F, Asplin JR (2007) A randomized, controlled trial of lactic acid bacteria for idiopathic hyperoxaluria. Clin J Am Soc Nephrol 2:745–749PubMed Goldfarb DS, Modersitzki F, Asplin JR (2007) A randomized, controlled trial of lactic acid bacteria for idiopathic hyperoxaluria. Clin J Am Soc Nephrol 2:745–749PubMed
32.
go back to reference Peck AB, Canales BK, Nguyen CQ (2016) Oxalate-degrading microorganisms or oxalate-degrading enzymes: which is the future therapy for enzymatic dissolution of calcium-oxalate uroliths in recurrent stone disease? Urolithiasis 44:45–50PubMed Peck AB, Canales BK, Nguyen CQ (2016) Oxalate-degrading microorganisms or oxalate-degrading enzymes: which is the future therapy for enzymatic dissolution of calcium-oxalate uroliths in recurrent stone disease? Urolithiasis 44:45–50PubMed
33.
go back to reference Gnanandarajah JS, Johnson TJ, Kim HB, Abrahante JE, Lulich JP, Murtaugh MP (2012) Comparative faecal microbiota of dogs with and without calcium oxalate stones. J Appl Microbiol 113:745–756PubMed Gnanandarajah JS, Johnson TJ, Kim HB, Abrahante JE, Lulich JP, Murtaugh MP (2012) Comparative faecal microbiota of dogs with and without calcium oxalate stones. J Appl Microbiol 113:745–756PubMed
34.
go back to reference Ticinesi A, Milani C, Guerra A et al (2018) Understanding the gut-kidney axis in nephrolithiasis: an analysis of the gut microbiota composition and functionality of stone formers. Gut 67:2097–2106PubMed Ticinesi A, Milani C, Guerra A et al (2018) Understanding the gut-kidney axis in nephrolithiasis: an analysis of the gut microbiota composition and functionality of stone formers. Gut 67:2097–2106PubMed
35.
go back to reference Tang R, Jiang Y, Tan A et al (2018) 16S rRNA gene sequencing reveals altered composition of gut microbiota in individuals with kidney stones. Urolithiasis 46:503–514PubMed Tang R, Jiang Y, Tan A et al (2018) 16S rRNA gene sequencing reveals altered composition of gut microbiota in individuals with kidney stones. Urolithiasis 46:503–514PubMed
36.
go back to reference Dornbier RA, Bajic P, Van Kuiken M et al. The microbiome of calcium-based urinary stones. Urolithiasis. doi: 10.1007/s00240-019-01146-w. Dornbier RA, Bajic P, Van Kuiken M et al. The microbiome of calcium-based urinary stones. Urolithiasis. doi: 10.1007/s00240-019-01146-w.
38.
go back to reference Reiss A, Jacobi M, Rusch K, Schwiertz A (2016) Association of dietary type with fecal microbiota and short chain fatty acids in vegans and omnivores. J Int Soc Microbiota 2:1–9 Reiss A, Jacobi M, Rusch K, Schwiertz A (2016) Association of dietary type with fecal microbiota and short chain fatty acids in vegans and omnivores. J Int Soc Microbiota 2:1–9
39.
go back to reference Zimmer J, Lange B, Frick JS et al. (2011) A vegan or vegetarian diet substantially alters the human colonic faecal microbiota. Eur J Clin Nutr. 10.138/ejcn.2011.141. Zimmer J, Lange B, Frick JS et al. (2011) A vegan or vegetarian diet substantially alters the human colonic faecal microbiota. Eur J Clin Nutr. 10.138/ejcn.2011.141.
40.
go back to reference Galecka M, Szachta P, Bartnicka A, Lykowska-Szuber L, Eder P, Schwiertz A (2013) Faecalibacterium prausnitzii and Crohn’s Disease—is there any connection? Pol J Microbiol 62:91–95PubMed Galecka M, Szachta P, Bartnicka A, Lykowska-Szuber L, Eder P, Schwiertz A (2013) Faecalibacterium prausnitzii and Crohn’s Disease—is there any connection? Pol J Microbiol 62:91–95PubMed
41.
go back to reference Enck P, Zimmermann K, Rusch K, Schwiertz A, Klosterhalfen S, Frick JS (2009) The effects of aging on the colonic bacterial microflora in adults. Gastroenterol 47:653–658 Enck P, Zimmermann K, Rusch K, Schwiertz A, Klosterhalfen S, Frick JS (2009) The effects of aging on the colonic bacterial microflora in adults. Gastroenterol 47:653–658
42.
go back to reference Gràcia-García S, Millán-Rodríguez F, Rousaud-Barón F et al (2011) Why and how we must analyze urinary calculi. Actas Urol Esp 35:354–362PubMed Gràcia-García S, Millán-Rodríguez F, Rousaud-Barón F et al (2011) Why and how we must analyze urinary calculi. Actas Urol Esp 35:354–362PubMed
43.
go back to reference Lau S, Gerhold K, Zimmermann K et al (2012) Oral application of bacterial lysate in infancy decreases the risk of atopic dermatitis in children with 1 atopic parent in a randomized, placebo-controlled trial. J Allergy Clin Immunol 129:1040–1047PubMed Lau S, Gerhold K, Zimmermann K et al (2012) Oral application of bacterial lysate in infancy decreases the risk of atopic dermatitis in children with 1 atopic parent in a randomized, placebo-controlled trial. J Allergy Clin Immunol 129:1040–1047PubMed
44.
go back to reference McFarland LV (2008) Meta-analysis of probiotics for the treatment of irritable bowel syndrome. World J Gastroenterol 14:2650–2661PubMedPubMedCentral McFarland LV (2008) Meta-analysis of probiotics for the treatment of irritable bowel syndrome. World J Gastroenterol 14:2650–2661PubMedPubMedCentral
46.
go back to reference Habermann W, Zimmermann K, Skarabis H, Kunze R, Rusch V (2002) Reduction of acute relapses in patients with chronic recurrent hypertrophic sinusitis during treatment with a bacterial immunostimulant (Enterococcus faecalis Bacteria of human origin—a medical probiotic). Arzneim Forsch/Drug Res 52(8):622–627 Habermann W, Zimmermann K, Skarabis H, Kunze R, Rusch V (2002) Reduction of acute relapses in patients with chronic recurrent hypertrophic sinusitis during treatment with a bacterial immunostimulant (Enterococcus faecalis Bacteria of human origin—a medical probiotic). Arzneim Forsch/Drug Res 52(8):622–627
48.
go back to reference Habermann W, Zimmerman K, Skarabis H, Kunze R, Rusch V (2001) Influence of a bacterial immunostimulant (human Enterococcus faecalis bacteria) on the occurrence of relapses in patients with chronic recurrent bronchitis. Arzneim Forsch/Drug Res 51(2):931–937 Habermann W, Zimmerman K, Skarabis H, Kunze R, Rusch V (2001) Influence of a bacterial immunostimulant (human Enterococcus faecalis bacteria) on the occurrence of relapses in patients with chronic recurrent bronchitis. Arzneim Forsch/Drug Res 51(2):931–937
49.
go back to reference Enck P, Zimmermann K, Menke G, Klosterhalfen S (2009) Randomized controlled treatment trial of irritable bowel syndrome with a probiotic E. coli preparation (DSM17252) compared to placebo. Z Gastroenterol 47:209–214PubMed Enck P, Zimmermann K, Menke G, Klosterhalfen S (2009) Randomized controlled treatment trial of irritable bowel syndrome with a probiotic E. coli preparation (DSM17252) compared to placebo. Z Gastroenterol 47:209–214PubMed
50.
go back to reference Haller D, Antoine JM, Bengmark S, Enck P, Rijkers GT, Lenoir-Wijnkoop I (2010) Guidance for substantiating the evidence for beneficial effects of probiotics: probiotics in chronic inflammatory bowel disease and the functional disorder irritable bowel syndrome. J Nutrition. https://doi.org/10.3945/jn.109.113746 CrossRef Haller D, Antoine JM, Bengmark S, Enck P, Rijkers GT, Lenoir-Wijnkoop I (2010) Guidance for substantiating the evidence for beneficial effects of probiotics: probiotics in chronic inflammatory bowel disease and the functional disorder irritable bowel syndrome. J Nutrition. https://​doi.​org/​10.​3945/​jn.​109.​113746 CrossRef
51.
go back to reference Martens U, Enck P, Ziesenib E (2010) Probiotic treatment of irritable bowel syndrome in children. German Med Sci 8:1–7 Martens U, Enck P, Ziesenib E (2010) Probiotic treatment of irritable bowel syndrome in children. German Med Sci 8:1–7
55.
go back to reference Woodmansey EJ, McMurdo ME, Macfarlane GT, Macfarlane S (2004) Comparison of compositions and metabolic activities of fecal microbiotas in young adults and in antibiotic-treated and non-antibiotic-treated elderly subjects. Appl Environ Microbiol 70:6113–6122PubMedPubMedCentral Woodmansey EJ, McMurdo ME, Macfarlane GT, Macfarlane S (2004) Comparison of compositions and metabolic activities of fecal microbiotas in young adults and in antibiotic-treated and non-antibiotic-treated elderly subjects. Appl Environ Microbiol 70:6113–6122PubMedPubMedCentral
56.
go back to reference Kushkevych I, Dordevic D, Vítezová M (2019) Analysis of pH dose-dependent growth of sulfate-reducing bacteria. Open Med (Wars) 14:66–74 Kushkevych I, Dordevic D, Vítezová M (2019) Analysis of pH dose-dependent growth of sulfate-reducing bacteria. Open Med (Wars) 14:66–74
Metadata
Title
The relationship between calcium oxalate lithiasis and chronic proinflammatory intestinal dysbiosis pattern: a prospective study
Authors
Félix Millán Rodríguez
Laia Sabiote Rubio
Irene Girón Nanne
Francisco Sánchez Martín
Esteban Emiliani
Oriol Angerri Feu
Publication date
01-08-2020
Publisher
Springer Berlin Heidelberg
Published in
Urolithiasis / Issue 4/2020
Print ISSN: 2194-7228
Electronic ISSN: 2194-7236
DOI
https://doi.org/10.1007/s00240-020-01181-y

Other articles of this Issue 4/2020

Urolithiasis 4/2020 Go to the issue