Metabolic evaluation and recurrence prevention for urinary stone patients: EAU guidelines

Area of Science:

• Urology
• Nephrology
• Metabolic Medicine

Background:

• The optimal strategy for metabolic evaluation in urinary stone patients remains undefined.
• Recurrent urinary stones significantly impact patient quality of life and healthcare costs.

Purpose of the Study:

• To establish an optimal strategy for metabolic evaluation and management to prevent recurrent urinary stones.
• To synthesize evidence for guiding the diagnostic and therapeutic approach in urolithiasis.

Main Methods:

• Comprehensive literature search across multiple databases for studies on metabolic evaluation and stone recurrence prevention.
• Focus on identifying the level of evidence for various diagnostic and therapeutic interventions.
• Development of diagnostic and therapeutic algorithms based on synthesized evidence.

Main Results:

• Reliable stone analysis and basic metabolic evaluation are recommended for all patients (Grade A).
• Patients are categorized into low-risk and high-risk groups for stone formation.
• Low-risk patients benefit from general fluid, nutritional, and lifestyle guidelines.
• High-risk patients require specific metabolic evaluation, including 24-hour urine collection (Grade A).
• Pharmacological treatment is recommended for calcium oxalate stones with specific urine abnormalities (Grades A/B).
• Thiazide treatment for calcium phosphate stones is recommended with hypercalciuria (Grade A).
• Potassium citrate and/or thiazide are recommended for renal tubular acidosis (RTA) based on urinary risk factors (Grade A/B).

Conclusions:

• Metabolic stone evaluation is essential for preventing urinary stone recurrence.
• Personalized treatment strategies, guided by stone type and metabolic assessment, are key to effective management.