GuidelinesMetabolic Evaluation and Recurrence Prevention for Urinary Stone Patients: EAU Guidelines☆
Introduction
The lifetime risk of stone formation in an individual is estimated at 5–10% [1], [2]. The recurrence rate after formation of an initial stone is reported to be as high as 50% at 5 yr and 80–90% at 10 yr [3]. People who form stones are more likely to have urinary metabolic abnormalities compared to a healthy population (level of evidence [LE] III/C) [4], [5], while patients who form recurrent stones tend to have more significant metabolic abnormalities than those with a single stone episode (LE III/C) [5], [6]. Because the removal of an existing calculus does not prevent further stone formation, patients should be thoroughly evaluated and educated on stone prevention. The aim of this review is to clarify the need and describe a method for evaluation of patients with first-time and recurrent stone formation. Diagnostic protocols for different etiologies of nephrolithiasis are provided. Specific therapeutic algorithms have been created to guide etiologic treatment of different stone types.
Section snippets
Evidence acquisition
A professional research librarian carried out literature searches for all sections of the urolithiasis guideline, covering the timeframe between 1976 until August 2013. Searches were carried out using the Cochrane Library Database of Systematic Reviews, the Cochrane Library of Controlled Clinical Trials, and Medline and Embase on the Dialog-Datastar platform. The searches used the controlled terminology of the respective databases. Both MesH and EMTREE were analyzed for relevant terms. In many
Evaluation of patient risk
All patients should undergo stone analysis using infrared spectroscopy or X-ray diffraction prior to metabolic evaluation [8]. Stone analysis should be performed in recurrent stone formers during each stone episode, even if the initial stone composition is known, because changes in stone content have been reported in recurrent stone formers [9], [10]. When stone analysis is not available, a specific workup of the patient should be performed (Table 1) [11].
After stone passage, every patient
Conclusions
After stone passage, every patient should be assigned to a group with low or high risk of stone formation. For correct classification, reliable stone analysis and basic evaluation of every patient are required. Low-risk stone formers may benefit by adopting general preventive measures regarding fluid and nutritional intake, as well as lifestyle improvements. For high-risk stone formers, a specific metabolic evaluation is required to guide individual treatment and prevent stone recurrence.
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