Kidney stone disease: evaluation and medical management.

Over the past 15 years we have developed a protocol for evaluation and medical management of urinary calculi that has proved quite effective. For all patients we include plain x-ray films of the urinary tract, intravenous pyelograms, urine cultures and sensitivity studies, serum and 24-hour urinary chemical determinations, and analysis of any stones recovered. Although the cause of calcium stones, the most common type of urinary calculi, has not been established, specific treatment regimens have been devised. Maintenance of a dilute urine remains the mainstay of therapy, and diuretics, alkalinizing or acidifying agents, and various specific drugs may be indicated, depending on laboratory findings. Surgery is not indicated unless the stone is large, is in the upper part of the urinary tract, or shows no signs of movement.