Metabolic evaluation and management of patients with urolithiasis by urologists: International survey-based overview of current practice.

INTRODUCTION

Appropriate metabolic evaluation and subsequent management is a keystone of urolithiasis treatment and stone recurrence risk reduction. The EAU guidelines currently recommend full metabolic evaluation in high-risk stone formers. However, practices in terms of metabolic evaluation and metabolic management vary widely globally, thus raising the risk of stone recurrence. To assess current practice among urologists in terms of metabolic analysis and management following surgery for stone disease in different countries.

METHODS

A Google Forms survey including 14 closed questions was circulated to urologists and residents worldwide via research group networks. Information was collected regarding baseline demographics as well as current practices in metabolic evaluation. Descriptive statistics were used to describe respondents' characteristics.

RESULTS

Overall, a total of 253 respondents participated worldwide, with 81% from Europe. In total, 56% were aged 30-39 years old and 37% declared a subspecialty interest in Endourology. Overall, 12% of the surveyed urologists never request a metabolic evaluation for their patients after surgery, whereas 51% reserve full metabolic evaluation only for high-risk stone formers, and 37% perform full metabolic analysis for each patient after surgery. Two respondents out of 3 routinely and autonomously interpret results, and 37% personally manage any metabolic abnormalities. The vast majority of respondents (89%) personally recommend general preventive measures to avoid stone recurrences, and 64% would routinely prescribe alkalinization treatment when indicated.

CONCLUSION

Despite the majority of respondents organizing full metabolic evaluation for their patients, only two out of three urologists are able to interpret results, and only one out of three personally manages any abnormalities detected. Moreover, a non-negligible percentage of urologists do not ask for metabolic evaluation at all. These results underscore the need for multidisciplinary management of patients with urolithiasis with nephrologist input, particularly in cases where a urologist may not have the necessary subspecialty expertise to manage complex metabolic stone disease.