Urinary stone incidence and seasonal variation in the Japanese population based on DPC data

Urinary stone incidence and seasonal variation in the Japanese population based on DPC data | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Urinary stone incidence and seasonal variation in the Japanese population based on DPC data Masanobu Yamazaki, Takashi Kawahara, Hiroki Ito, Akihito Hashizume, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6724336/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction Several studies have examined the association between the incidence of urolithiasis and ambient temperature. While some have reported a significant relationship, others have found no clear correlation. In Japan, although a few studies have addressed this issue, large-scale investigations remain limited. This study aims to evaluate the seasonal variation in the incidence of urolithiasis in Japan using a large health insurance claims database. Methods We analyzed health insurance claims data from 780,387 patients in Japan diagnosed with urolithiasis between April 2008 and 2021. The data were obtained from Medical Data Vision which is based on the Diagnosis Procedure Combination system and includes diagnostic codes and dates. Monthly temperature data at the time of diagnosis were derived from the 30-year average monthly temperatures in Tokyo, as reported by the Japan Meteorological Agency. Results Among patients diagnosed with urolithiasis, 596,080 had ureteral stones (344,392 men and 143,427 women), 276,100 had renal stones (172,184 men and 103,916 women), 45,087 had bladder stones (35,094 men and 9,993 women), and 4,319 had urethral stones (4,010 men and 309 women). For ureteral stones, the median age of onset in men was 21 years younger than in women (46 years in men vs. 67 years in women). The peak incidence age for renal stones was 66 years in men and 69 years in women, while for bladder stones, it was 78 years in men and 76 years in women. Urethral stones were predominantly seen in men, with a peak age of 66 years; due to the small number of female cases, no clear age-related pattern was observed. Among patients with ureteral stones, diagnoses in men were more frequent during the warmer months (April to August). In contrast, women showed no significant seasonal variation in the incidence of ureteral stones, including lower ureteral stones. No distinct seasonal trends were observed for renal, bladder, or urethral stones; however, diagnoses in April tended to be more frequent across all types. Conclusion The incidence of ureteral stones in men increased during periods of higher ambient temperature, suggesting a potential association with seasonal and environmental factors. Earth and environmental sciences/Climate sciences Health sciences/Risk factors Health sciences/Urology Figures Figure 1 Figure 2 INTRODUCTION Urolithiasis is a common urological condition with a globally increasing prevalence in recent years. This trend is believed to be influenced by various factors, including diet, lifestyle, and environmental conditions such as climate ( 1 , 2 ). Among these, ambient temperature is thought to play a particularly significant role in stone formation. High temperatures can promote dehydration and urinary concentration, thereby increasing the risk of stone development ( 3 ). A report from the United States indicated that the prevalence of kidney stones was 10.6% in men and 7.1% in women ( 3 ). Several studies from countries such as Taiwan, New Zealand, the United States, and Italy have explored the relationship between ambient temperature and the incidence of urolithiasis or renal colic, with many showing a higher frequency during warmer seasons ( 4 – 7 ). For example, one American study reported a 16% higher incidence of renal colic during the summer months of June to August compared to the winter months of December to February ( 6 ). In Japan, although a few small-scale studies have been conducted ( 8 ), no large-scale nationwide investigation has been undertaken. Therefore, the objective of this study was to evaluate the seasonal variation in the incidence of urolithiasis in Japan using a large-scale national health insurance claims database. MATERIALS & METHODS We analyzed data from 780,387 patients diagnosed with urinary tract stones (ICD-10 code N20) between April 2008 and August 2021, using receipt data collected by Medical Data Vision (MDV), a Japanese health data company. The total number of stone diagnoses exceeded the total number of patients because some individuals had stones in multiple anatomical sites. Among patients with ureteral stones, some were classified as having both upper and lower ureteral stones. Therefore, we also evaluated differences in sex, age, and seasonal variation based on stone location. Age, sex, and stone location were determined using receipt data from the month of diagnosis. Monthly average temperatures in Tokyo, published by the Japan Meteorological Agency, were used as the environmental temperature at the time of diagnosis. We analyzed the average number of stone diagnoses per month by sex. For ureteral stones with clearly defined upper or lower locations, monthly diagnosis trends by sex were also examined. Finally, we compared the age-specific incidence of each type of urinary tract stone between men and women. Original Data is commercially available from Medical Data Vision (Tokyo, Japan). Institutional Review Board of Yokohama City University Medical Center (Yokohama, JAPAN) [Ref: D1507018]. Informed consent to participate in the study were was obtained from all subjects by in the opt-out style manner. Experimental procedures were conducted in accordance with the ethical standards of the Helsinki Declaration. Statistical analyses The participants’ characteristics and scores were analyzed by the Mann-Whitney U and one-factor analysis of variance (ANOVA) tests, and the prevalence of daytime frequency, nocturia, urgency, UUI, SUI, MUI, and PMD was analyzed by a chi-square test using the Graph Pad Prism software program (Graph Pad Software, La Jolla, CA, USA). P values of < 0.05 were considered to indicate statistical significance. RESULTS The total number of patients with urolithiasis was 780,387. Among them, there were 276,100 patients with renal calculi (172,184 males and 103,916 females), 487,819 with ureteral calculi (344,392 males and 143,427 females), 45,087 with bladder calculi (35,094 males and 9,993 females), and 4,319 with urethral calculi (4,010 males and 309 females) [Table 1 ]. Table 1 Patients' Number in each stone Type of stones male female Ureteral stone 344,392 143,427 Kidney stone 172,184 103,916 Bladder stone 35,094 9,993 Urethral stone 4,010 309 The trend in average temperature in Japan is shown in Supplementary Fig. 1. The average temperature was 14.9°C in spring (March to May), 25.6°C in summer (June to August), 18.7°C in autumn (September to November), and 7.0°C in winter (December to February). The monthly average number of stone diagnoses by sex and stone type is shown in Fig. 1 . For male patients with ureteral calculi, the number of diagnoses was higher in July and August, when the average temperature was also high [Fig. 1 a]. A similar trend was observed in females, with more ureteral stone cases from April to August, when temperatures rose; however, the peak was less pronounced compared to males [Fig. 1 a). For renal and bladder calculi, both males and females showed a peak in diagnoses in April, with the lowest number in March [Fig. 1 b and 1 c]. Regarding urethral calculi, males showed a peak in April, whereas in females, there was no significant variation in the number of diagnoses across the months [Fig. 1 d]. For ureteral calculi, the peak age of incidence was 46 years in males and 67 years in females, indicating that the peak occurred approximately 20 years earlier in males [Fig. 2 a]. Regarding renal calculi, the peak ages were similar in both sexes, with males peaking at 66 years and females at 69 years [Fig. 2 b]. For bladder calculi, the peak age was 78 years in males and 76 years in females, showing little difference between the sexes [Fig. 2 c]. As for urethral calculi, the majority of cases were male, with a peak at 66 years of age [Fig. 2 d]. In females, the number of cases was markedly lower, and no significant age-related variation was observed [Fig. 2 d]. DISCUSSION This study analyzed approximately 780,000 patients with urolithiasis, which is the largest cohort compared to previous reports. Although the database used in this study did not include information on stone composition, it covers 31.3% of all hospitals in Japan and one third of all DPC hospitals, thus representing a significant portion of the Japanese hospital system and providing a sufficiently large sample to understand the nationwide characteristics of urolithiasis patients. Regarding peak incidence, ureteral stones showed a peak at 46 years in men and 67 years in women, with men peaking about 20 years earlier. This result aligns with previous reports from Australia, New Zealand, Taiwan, and Germany, where the peak incidence occurred in middle age (40–60 years) ( 4 , 5 , 9 , 10 ). While no significant sex-based difference in peak incidence was observed for kidney, bladder, or urethral stones, a notable difference was seen for ureteral stones. In the present study, men exhibited a bimodal distribution with peaks at approximately 31–40 and 51–60 years. A similar bimodal pattern was reported in Australia, where calcium oxalate stones peaked in these age groups ( 1 ). Although stone composition was not available in this study, dietary and environmental factors may have influenced these age-related trends. Interestingly, a higher prevalence of kidney, ureteral, and bladder stones was observed in April. This may be attributed to the timing of annual health check-ups with ultrasonography in schools and workplaces. Additionally, a seasonal trend was observed for ureteral stones in men, which were more common during high-temperature months (August, July, and September in Tokyo), suggesting a correlation with ambient temperature. This seasonal variation was not seen in women. Previous studies from Taiwan, New Zealand, and Australia ( 4 , 5 , 9 ) also reported seasonal peaks in ureteral stone incidence from July to September, February to March, and March to May, respectively. In New Zealand and Australia, the peak incidence occurred 1–2 months after the hottest months, possibly due to a lag between stone formation and symptomatic presentation (e.g., renal colic). In contrast, in our study and in the Taiwanese study, diagnoses were based on insurance claims data, likely capturing stone detection without delay from symptom onset. Two major environmental factors implicated in ureteral stone formation are elevated ambient temperature and sunlight exposure. High temperatures promote fluid loss through sweating, leading to concentrated urine and an increased risk of crystalluria ( 11 ). A 14% increase in renal colic risk has been reported with outdoor temperature rising from 0°C to 20°C ( 6 ). Sunlight exposure has also been associated with hypercalciuria, possibly due to increased 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D levels, enhancing intestinal calcium absorption and urinary calcium excretion ( 12 , 13 ). This study has several limitations. First, the claims database lacks detailed clinical data, and the timing of diagnosis may not accurately reflect symptom onset. Second, we did not account for other environmental factors such as humidity, which has been shown to increase renal colic risk in regions with humidity below 45% ( 7 ). Third, stone composition could not be analyzed. Further studies including clinical and biochemical data are needed to validate these findings. Despite these limitations, this study provides valuable insights by analyzing the largest urolithiasis cohort to date, identifying seasonal and sex-related trends in incidence that may inform public health strategies and patient education. CONCLUSION The incidence of ureteral stones increased among male patients during periods of high temperature. Declarations CONFLICTS OF INTEREST We declare no conflicts of interests Author Contribution MY, TK, wrothe tge main manuscript, MY, TK, AH prepared figures and table, HI, HH, DU, JT, KM, HU critical comment. All authores reviewed the manuscript. ACKNOWLEDGMENTS There are no applicable grant numbers associated with this study. Data Availability The raw data to create tables and figures are available as a supplementary file References Lee, M. C. & Bariol, S. V. Changes in upper urinary tract stone composition in Australia over the past 30 years. BJU Int. 112 (Suppl 2), 65–68 (2013). Scales, C. D. Jr., Smith, A. C., Hanley, J. M. & Saigal, C. S. Urologic Diseases in America P. Prevalence of kidney stones in the United States. Eur. Urol. 62 (1), 160–165 (2012). Fakheri, R. J. & Goldfarb, D. S. Ambient temperature as a contributor to kidney stone formation: implications of global warming. Kidney Int. 79 (11), 1178–1185 (2011). Chen, Y. K., Lin, H. C., Chen, C. S. & Yeh, S. D. Seasonal variations in urinary calculi attacks and their association with climate: a population based study. J. Urol. 179 (2), 564–569 (2008). Lo, S. S. et al. Seasonal variation in the acute presentation of urinary calculi over 8 years in Auckland, New Zealand. BJU Int. 106 (1), 96–101 (2010). Chauhan, V., Eskin, B., Allegra, J. R. & Cochrane, D. G. Effect of season, age, and gender on renal colic incidence. Am. J. Emerg. Med. 22 (7), 560–563 (2004). Boscolo-Berto, R. et al. Do weather conditions influence the onset of renal colic? A novel approach to analysis. Urol. Int. 80 (1), 19–25 (2008). Fukuhara, H., Ichiyanagi, O., Kakizaki, H., Naito, S. & Tsuchiya, N. Clinical relevance of seasonal changes in the prevalence of ureterolithiasis in the diagnosis of renal colic. Urolithiasis 44 (6), 529–537 (2016). Albert Tiu, V. T., Gubicak, S., Knight, P. & Haxhimolla, H. Seasonal Variation of Acute Urolithiasis at an Australian Tertiary Hospi. Australasian Med. J. 3 (13), 851–854 (2010). Siener, R. et al. Urinary stone composition in Germany: results from 45,783 stone analyses. World J. Urol. 40 (7), 1813–1820 (2022). Borghi, L. et al. Relationship between supersaturation and calcium oxalate crystallization in normals and idiopathic calcium oxalate stone formers. Kidney Int. 55 (3), 1041–1050 (1999). Parry, E. S. & Lister, I. S. Sunlight and hypercalciuria. Lancet 1 (7915), 1063–1065 (1975). Lips, P. Vitamin D deficiency and secondary hyperparathyroidism in the elderly: consequences for bone loss and fractures and therapeutic implications. Endocr. Rev. 22 (4), 477–501 (2001). 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6724336","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":511707917,"identity":"c868f55d-ee9a-4f0d-86b8-d249e73d04f3","order_by":0,"name":"Masanobu Yamazaki","email":"","orcid":"","institution":"Yokohama City University Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Masanobu","middleName":"","lastName":"Yamazaki","suffix":""},{"id":511707918,"identity":"0baa22fb-4ca9-44a0-9ac4-8500fcb3965e","order_by":1,"name":"Takashi Kawahara","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABFklEQVRIie3RMUvEMBTA8RcK1+WVWwtF/QophUOwWPwmDYW4CPoBDg0UOgm3Fk70K+jmmKOQ6dC1okMnXetYuMFYrLe01lEw/+lB+JGXFsBk+pNNAIhwAdCSMqYhgPt1QEQ/wI4gTlhVn/FfEz0gBn5eF1syVGQr9t7c70OEcuYhfWSLZbqqYB6Ctey/BpEXnrPWizmCa/LM8heVUFAcyJUcWOxYeCTTZAqqJaI8mblEFEDyuJ9M39KmaQnJNHlgN6PE5cp1PomTWn5OJbsdJeUrP2jJWpGqpklwV/KExorj0FvsBQ+emuwc7MvTWsabw53rMllV9Tzc9Qe+WNdFd3zUDnol9PMfxbboe9ob+6cmk8n0X/oAvpZdcCkg9h4AAAAASUVORK5CYII=","orcid":"","institution":"Yokohama City University Medical Center","correspondingAuthor":true,"prefix":"","firstName":"Takashi","middleName":"","lastName":"Kawahara","suffix":""},{"id":511707919,"identity":"1dc5f1f9-e265-400d-a602-0d9adf64eaa9","order_by":2,"name":"Hiroki Ito","email":"","orcid":"","institution":"Yokohama City University","correspondingAuthor":false,"prefix":"","firstName":"Hiroki","middleName":"","lastName":"Ito","suffix":""},{"id":511707920,"identity":"96b16611-52aa-4ae0-9cfc-0df4b8d7b352","order_by":3,"name":"Akihito Hashizume","email":"","orcid":"","institution":"Yokohama City University Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Akihito","middleName":"","lastName":"Hashizume","suffix":""},{"id":511707921,"identity":"ec95ceff-c5d8-47e4-8a42-715bccf0fce1","order_by":4,"name":"Hisashi Hasumi","email":"","orcid":"","institution":"Yokohama City University","correspondingAuthor":false,"prefix":"","firstName":"Hisashi","middleName":"","lastName":"Hasumi","suffix":""},{"id":511707922,"identity":"6d18ef34-a1e3-44ed-9a96-4afd4a5dd007","order_by":5,"name":"Daiki Ueno","email":"","orcid":"","institution":"Yokohama City University Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Daiki","middleName":"","lastName":"Ueno","suffix":""},{"id":511707923,"identity":"5ee4fcef-2985-4606-97d9-fd78e2d8cdcf","order_by":6,"name":"Jun-ichi Teranishi","email":"","orcid":"","institution":"Yokohama City University Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Jun-ichi","middleName":"","lastName":"Teranishi","suffix":""},{"id":511707924,"identity":"aed3f308-3f9d-4b29-9d92-b2c50de8da1c","order_by":7,"name":"Kazuhide Makiyama","email":"","orcid":"","institution":"Yokohama City University","correspondingAuthor":false,"prefix":"","firstName":"Kazuhide","middleName":"","lastName":"Makiyama","suffix":""},{"id":511707925,"identity":"5cb93256-af3e-4049-8386-5010688d1b26","order_by":8,"name":"Hiroji Uemura","email":"","orcid":"","institution":"Yokohama City University Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Hiroji","middleName":"","lastName":"Uemura","suffix":""}],"badges":[],"createdAt":"2025-05-22 11:08:23","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6724336/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6724336/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":90982968,"identity":"df2d99c3-a5be-43f1-97e0-a82fc66aeabc","added_by":"auto","created_at":"2025-09-10 09:33:21","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":497072,"visible":true,"origin":"","legend":"\u003cp\u003eNumber of patients of each stone in males and females by months. a) Ureteral, b) Kidney, c) Bladder, and d) Urethral stone. For male patients with ureteral calculi, the number was higher in July and August, when the average temperature was also high.\u003c/p\u003e","description":"","filename":"fig1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6724336/v1/d6bb4a0f25ffe3fb4b1434e6.jpg"},{"id":90981699,"identity":"ad0acc56-852b-4c4b-a0ef-168d34f15109","added_by":"auto","created_at":"2025-09-10 09:25:21","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":570682,"visible":true,"origin":"","legend":"\u003cp\u003eNumber of patients of each stone in males and females by age. a) Ureteral, b) Kidney, c) Bladder, and d) Urethral stone. For ureteral stones, the peak age of onset was 46 years for males and 67 years for females, with males reaching the peak about 20 years earlier.\u003c/p\u003e","description":"","filename":"fig2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6724336/v1/4b686ab3343a22564f575d65.jpg"},{"id":93031055,"identity":"f1554cf8-c0f3-4bd1-a80c-3b408e787847","added_by":"auto","created_at":"2025-10-08 10:09:21","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1448232,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6724336/v1/bb119070-7eab-4f0f-a1b6-9a6710e9908c.pdf"},{"id":90981697,"identity":"179f04b3-098c-4d7d-91b0-0a3c714446ba","added_by":"auto","created_at":"2025-09-10 09:25:21","extension":"pptx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":66383,"visible":true,"origin":"","legend":"","description":"","filename":"Stonsuppl.pptx","url":"https://assets-eu.researchsquare.com/files/rs-6724336/v1/b823c107c98c4f855ead48f5.pptx"},{"id":90981738,"identity":"66d62a5f-d25e-46bb-a1d7-3467be9119b3","added_by":"auto","created_at":"2025-09-10 09:25:29","extension":"pdf","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":136492614,"visible":true,"origin":"","legend":"","description":"","filename":"baselinelist1.0.1.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6724336/v1/327e83f446b97978c9308198.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Urinary stone incidence and seasonal variation in the Japanese population based on DPC data","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eUrolithiasis is a common urological condition with a globally increasing prevalence in recent years. This trend is believed to be influenced by various factors, including diet, lifestyle, and environmental conditions such as climate (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Among these, ambient temperature is thought to play a particularly significant role in stone formation. High temperatures can promote dehydration and urinary concentration, thereby increasing the risk of stone development (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eA report from the United States indicated that the prevalence of kidney stones was 10.6% in men and 7.1% in women (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Several studies from countries such as Taiwan, New Zealand, the United States, and Italy have explored the relationship between ambient temperature and the incidence of urolithiasis or renal colic, with many showing a higher frequency during warmer seasons (\u003cspan additionalcitationids=\"CR5 CR6\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). For example, one American study reported a 16% higher incidence of renal colic during the summer months of June to August compared to the winter months of December to February (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn Japan, although a few small-scale studies have been conducted (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e), no large-scale nationwide investigation has been undertaken. Therefore, the objective of this study was to evaluate the seasonal variation in the incidence of urolithiasis in Japan using a large-scale national health insurance claims database.\u003c/p\u003e"},{"header":"MATERIALS \u0026 METHODS","content":"\u003cp\u003eWe analyzed data from 780,387 patients diagnosed with urinary tract stones (ICD-10 code N20) between April 2008 and August 2021, using receipt data collected by Medical Data Vision (MDV), a Japanese health data company. The total number of stone diagnoses exceeded the total number of patients because some individuals had stones in multiple anatomical sites. Among patients with ureteral stones, some were classified as having both upper and lower ureteral stones. Therefore, we also evaluated differences in sex, age, and seasonal variation based on stone location. Age, sex, and stone location were determined using receipt data from the month of diagnosis. Monthly average temperatures in Tokyo, published by the Japan Meteorological Agency, were used as the environmental temperature at the time of diagnosis. We analyzed the average number of stone diagnoses per month by sex. For ureteral stones with clearly defined upper or lower locations, monthly diagnosis trends by sex were also examined. Finally, we compared the age-specific incidence of each type of urinary tract stone between men and women. Original Data is commercially available from Medical Data Vision (Tokyo, Japan). Institutional Review Board of Yokohama City University Medical Center (Yokohama, JAPAN) [Ref: D1507018]. Informed consent to participate in the study were was obtained from all subjects by in the opt-out style manner. Experimental procedures were conducted in accordance with the ethical standards of the Helsinki Declaration.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analyses\u003c/h2\u003e\u003cp\u003eThe participants\u0026rsquo; characteristics and scores were analyzed by the Mann-Whitney \u003cem\u003eU\u003c/em\u003e and one-factor analysis of variance (ANOVA) tests, and the prevalence of daytime frequency, nocturia, urgency, UUI, SUI, MUI, and PMD was analyzed by a chi-square test using the Graph Pad Prism software program (Graph Pad Software, La Jolla, CA, USA). P values of \u0026lt;\u0026thinsp;0.05 were considered to indicate statistical significance.\u003c/p\u003e\u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eThe total number of patients with urolithiasis was 780,387. Among them, there were 276,100 patients with renal calculi (172,184 males and 103,916 females), 487,819 with ureteral calculi (344,392 males and 143,427 females), 45,087 with bladder calculi (35,094 males and 9,993 females), and 4,319 with urethral calculi (4,010 males and 309 females) [Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePatients' Number in each stone\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eType of stones\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003emale\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003efemale\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eUreteral stone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e344,392\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e143,427\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eKidney stone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e172,184\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e103,916\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eBladder stone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e35,094\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9,993\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eUrethral stone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4,010\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e309\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe trend in average temperature in Japan is shown in Supplementary Fig.\u0026nbsp;1. The average temperature was 14.9\u0026deg;C in spring (March to May), 25.6\u0026deg;C in summer (June to August), 18.7\u0026deg;C in autumn (September to November), and 7.0\u0026deg;C in winter (December to February). The monthly average number of stone diagnoses by sex and stone type is shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. For male patients with ureteral calculi, the number of diagnoses was higher in July and August, when the average temperature was also high [Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003ea]. A similar trend was observed in females, with more ureteral stone cases from April to August, when temperatures rose; however, the peak was less pronounced compared to males [Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003ea). For renal and bladder calculi, both males and females showed a peak in diagnoses in April, with the lowest number in March [Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eb and \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003ec]. Regarding urethral calculi, males showed a peak in April, whereas in females, there was no significant variation in the number of diagnoses across the months [Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003ed].\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eFor ureteral calculi, the peak age of incidence was 46 years in males and 67 years in females, indicating that the peak occurred approximately 20 years earlier in males [Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003ea]. Regarding renal calculi, the peak ages were similar in both sexes, with males peaking at 66 years and females at 69 years [Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eb]. For bladder calculi, the peak age was 78 years in males and 76 years in females, showing little difference between the sexes [Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003ec]. As for urethral calculi, the majority of cases were male, with a peak at 66 years of age [Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003ed]. In females, the number of cases was markedly lower, and no significant age-related variation was observed [Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003ed].\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis study analyzed approximately 780,000 patients with urolithiasis, which is the largest cohort compared to previous reports. Although the database used in this study did not include information on stone composition, it covers 31.3% of all hospitals in Japan and one third of all DPC hospitals, thus representing a significant portion of the Japanese hospital system and providing a sufficiently large sample to understand the nationwide characteristics of urolithiasis patients.\u003c/p\u003e\u003cp\u003eRegarding peak incidence, ureteral stones showed a peak at 46 years in men and 67 years in women, with men peaking about 20 years earlier. This result aligns with previous reports from Australia, New Zealand, Taiwan, and Germany, where the peak incidence occurred in middle age (40\u0026ndash;60 years) (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). While no significant sex-based difference in peak incidence was observed for kidney, bladder, or urethral stones, a notable difference was seen for ureteral stones. In the present study, men exhibited a bimodal distribution with peaks at approximately 31\u0026ndash;40 and 51\u0026ndash;60 years. A similar bimodal pattern was reported in Australia, where calcium oxalate stones peaked in these age groups (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Although stone composition was not available in this study, dietary and environmental factors may have influenced these age-related trends.\u003c/p\u003e\u003cp\u003eInterestingly, a higher prevalence of kidney, ureteral, and bladder stones was observed in April. This may be attributed to the timing of annual health check-ups with ultrasonography in schools and workplaces. Additionally, a seasonal trend was observed for ureteral stones in men, which were more common during high-temperature months (August, July, and September in Tokyo), suggesting a correlation with ambient temperature. This seasonal variation was not seen in women. Previous studies from Taiwan, New Zealand, and Australia (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e) also reported seasonal peaks in ureteral stone incidence from July to September, February to March, and March to May, respectively. In New Zealand and Australia, the peak incidence occurred 1\u0026ndash;2 months after the hottest months, possibly due to a lag between stone formation and symptomatic presentation (e.g., renal colic). In contrast, in our study and in the Taiwanese study, diagnoses were based on insurance claims data, likely capturing stone detection without delay from symptom onset. Two major environmental factors implicated in ureteral stone formation are elevated ambient temperature and sunlight exposure. High temperatures promote fluid loss through sweating, leading to concentrated urine and an increased risk of crystalluria (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). A 14% increase in renal colic risk has been reported with outdoor temperature rising from 0\u0026deg;C to 20\u0026deg;C (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Sunlight exposure has also been associated with hypercalciuria, possibly due to increased 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D levels, enhancing intestinal calcium absorption and urinary calcium excretion (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThis study has several limitations. First, the claims database lacks detailed clinical data, and the timing of diagnosis may not accurately reflect symptom onset. Second, we did not account for other environmental factors such as humidity, which has been shown to increase renal colic risk in regions with humidity below 45% (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Third, stone composition could not be analyzed. Further studies including clinical and biochemical data are needed to validate these findings. Despite these limitations, this study provides valuable insights by analyzing the largest urolithiasis cohort to date, identifying seasonal and sex-related trends in incidence that may inform public health strategies and patient education.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThe incidence of ureteral stones increased among male patients during periods of high temperature.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003ch2\u003eCONFLICTS OF INTEREST\u003c/h2\u003e\u003cp\u003eWe declare no conflicts of interests\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eMY, TK, wrothe tge main manuscript, MY, TK, AH prepared figures and table, HI, HH, DU, JT, KM, HU critical comment. All authores reviewed the manuscript.\u003c/p\u003e\u003ch2\u003eACKNOWLEDGMENTS\u003c/h2\u003e\u003cp\u003eThere are no applicable grant numbers associated with this study.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe raw data to create tables and figures are available as a supplementary file\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eLee, M. C. \u0026amp; Bariol, S. V. Changes in upper urinary tract stone composition in Australia over the past 30 years. \u003cem\u003eBJU Int.\u003c/em\u003e \u003cb\u003e112\u003c/b\u003e (Suppl 2), 65\u0026ndash;68 (2013).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eScales, C. D. Jr., Smith, A. C., Hanley, J. M. \u0026amp; Saigal, C. S. Urologic Diseases in America P. Prevalence of kidney stones in the United States. \u003cem\u003eEur. Urol.\u003c/em\u003e \u003cb\u003e62\u003c/b\u003e (1), 160\u0026ndash;165 (2012).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFakheri, R. J. \u0026amp; Goldfarb, D. S. Ambient temperature as a contributor to kidney stone formation: implications of global warming. \u003cem\u003eKidney Int.\u003c/em\u003e \u003cb\u003e79\u003c/b\u003e (11), 1178\u0026ndash;1185 (2011).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChen, Y. K., Lin, H. C., Chen, C. S. \u0026amp; Yeh, S. D. Seasonal variations in urinary calculi attacks and their association with climate: a population based study. \u003cem\u003eJ. Urol.\u003c/em\u003e \u003cb\u003e179\u003c/b\u003e (2), 564\u0026ndash;569 (2008).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLo, S. S. et al. Seasonal variation in the acute presentation of urinary calculi over 8 years in Auckland, New Zealand. \u003cem\u003eBJU Int.\u003c/em\u003e \u003cb\u003e106\u003c/b\u003e (1), 96\u0026ndash;101 (2010).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChauhan, V., Eskin, B., Allegra, J. R. \u0026amp; Cochrane, D. G. Effect of season, age, and gender on renal colic incidence. \u003cem\u003eAm. J. Emerg. Med.\u003c/em\u003e \u003cb\u003e22\u003c/b\u003e (7), 560\u0026ndash;563 (2004).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBoscolo-Berto, R. et al. Do weather conditions influence the onset of renal colic? A novel approach to analysis. \u003cem\u003eUrol. Int.\u003c/em\u003e \u003cb\u003e80\u003c/b\u003e (1), 19\u0026ndash;25 (2008).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFukuhara, H., Ichiyanagi, O., Kakizaki, H., Naito, S. \u0026amp; Tsuchiya, N. Clinical relevance of seasonal changes in the prevalence of ureterolithiasis in the diagnosis of renal colic. \u003cem\u003eUrolithiasis\u003c/em\u003e \u003cb\u003e44\u003c/b\u003e (6), 529\u0026ndash;537 (2016).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAlbert Tiu, V. T., Gubicak, S., Knight, P. \u0026amp; Haxhimolla, H. Seasonal Variation of Acute Urolithiasis at an Australian Tertiary Hospi. \u003cem\u003eAustralasian Med. J.\u003c/em\u003e \u003cb\u003e3\u003c/b\u003e (13), 851\u0026ndash;854 (2010).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSiener, R. et al. Urinary stone composition in Germany: results from 45,783 stone analyses. \u003cem\u003eWorld J. Urol.\u003c/em\u003e \u003cb\u003e40\u003c/b\u003e (7), 1813\u0026ndash;1820 (2022).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBorghi, L. et al. Relationship between supersaturation and calcium oxalate crystallization in normals and idiopathic calcium oxalate stone formers. \u003cem\u003eKidney Int.\u003c/em\u003e \u003cb\u003e55\u003c/b\u003e (3), 1041\u0026ndash;1050 (1999).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eParry, E. S. \u0026amp; Lister, I. S. Sunlight and hypercalciuria. \u003cem\u003eLancet\u003c/em\u003e \u003cb\u003e1\u003c/b\u003e (7915), 1063\u0026ndash;1065 (1975).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLips, P. Vitamin D deficiency and secondary hyperparathyroidism in the elderly: consequences for bone loss and fractures and therapeutic implications. \u003cem\u003eEndocr. Rev.\u003c/em\u003e \u003cb\u003e22\u003c/b\u003e (4), 477\u0026ndash;501 (2001).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-6724336/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6724336/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eIntroduction\u003c/p\u003e\u003cp\u003eSeveral studies have examined the association between the incidence of urolithiasis and ambient temperature. While some have reported a significant relationship, others have found no clear correlation. In Japan, although a few studies have addressed this issue, large-scale investigations remain limited. This study aims to evaluate the seasonal variation in the incidence of urolithiasis in Japan using a large health insurance claims database.\u003c/p\u003e\u003cp\u003eMethods\u003c/p\u003e\u003cp\u003eWe analyzed health insurance claims data from 780,387 patients in Japan diagnosed with urolithiasis between April 2008 and 2021. The data were obtained from Medical Data Vision which is based on the Diagnosis Procedure Combination system and includes diagnostic codes and dates. Monthly temperature data at the time of diagnosis were derived from the 30-year average monthly temperatures in Tokyo, as reported by the Japan Meteorological Agency.\u003c/p\u003e\u003cp\u003eResults\u003c/p\u003e\u003cp\u003eAmong patients diagnosed with urolithiasis, 596,080 had ureteral stones (344,392 men and 143,427 women), 276,100 had renal stones (172,184 men and 103,916 women), 45,087 had bladder stones (35,094 men and 9,993 women), and 4,319 had urethral stones (4,010 men and 309 women).\u003c/p\u003e\u003cp\u003eFor ureteral stones, the median age of onset in men was 21 years younger than in women (46 years in men vs. 67 years in women). The peak incidence age for renal stones was 66 years in men and 69 years in women, while for bladder stones, it was 78 years in men and 76 years in women. Urethral stones were predominantly seen in men, with a peak age of 66 years; due to the small number of female cases, no clear age-related pattern was observed. Among patients with ureteral stones, diagnoses in men were more frequent during the warmer months (April to August). In contrast, women showed no significant seasonal variation in the incidence of ureteral stones, including lower ureteral stones. No distinct seasonal trends were observed for renal, bladder, or urethral stones; however, diagnoses in April tended to be more frequent across all types.\u003c/p\u003e\u003cp\u003eConclusion\u003c/p\u003e\u003cp\u003eThe incidence of ureteral stones in men increased during periods of higher ambient temperature, suggesting a potential association with seasonal and environmental factors.\u003c/p\u003e","manuscriptTitle":"Urinary stone incidence and seasonal variation in the Japanese population based on DPC data","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-10 09:25:17","doi":"10.21203/rs.3.rs-6724336/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"22c8df79-b065-4c04-9236-744b0353812e","owner":[],"postedDate":"September 10th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":54340960,"name":"Earth and environmental sciences/Climate sciences"},{"id":54340961,"name":"Health sciences/Risk factors"},{"id":54340962,"name":"Health sciences/Urology"}],"tags":[],"updatedAt":"2026-04-05T08:23:59+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-10 09:25:17","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6724336","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6724336","identity":"rs-6724336","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}