Clinical correlates of the gross, radiographic, and histologic features of urinary matrix calculi

We present five patients with urinary matrix calculi, which, in contrast to the normally brittle calcigerous calculi, are soft, pliable, and amorphous. Common clinical features include a history of calcigerous stone disease, renal surgery, urinary obstruction or stasis, and chronic infection with Proteus species or coliforms. The diagnosis is usually made at surgery, but certain preoperative radiographic findings may be suggestive. Matrix calculi are radiolucent on plain abdominal films, although their appearance on nonenhanced CT scans is similar to that of calcigerous calculi despite their small mineral content. Extracorporeal shockwave lithotripsy is ineffective; open or percutaneous techniques are necessary. Histologic inspection reveals laminar concentric rings of organized matrix with an orderly, layered deposition of minerals. Histochemical investigation can provide insight into the possible sequence of events in normal calculogenesis. The successful management of urinary matrix calculi depends on a high index of suspicion and a thorough knowledge of their clinicopathologic features.