title: Differences in urine volume and supersaturation in 2 physician networks.
abstract: OBJECTIVE
  We determined whether a network of practices devoted to a broad range of urological care would achieve a decrease in metabolic stone risk comparable to that achieved by a network of similar practices that emphasized kidney stone management as a distinct specialized interest, provided that each was given equivalent access to high level urine testing and software support.
  
  
  METHODS
  Pretreatment and treatment 24-hour urine samples were obtained from patients in a large network of practices related by the shared use of lithotripsy facilities and instruments (group 2) and a contrasting network of practices that emphasize stone treatment over other concerns (group 1). All known urine risk factors, including supersaturation, were measured and calculated.
  
  
  RESULTS
  Treatment supersaturation values in group 2 exceeded those in group 1. The reason was unpredicted and unexplained but highly consistent lower urine volume in group 2 patients that was present before and persisted during treatment. Group 2 physicians mostly achieved changes in urine volume and stone risk factors equivalent to those of group 1 physicians but began with higher supersaturation due to lower urine volume.
  
  
  CONCLUSIONS
  A network of physicians not specialized for stone care may achieve a decreased risk equivalent to that of more specialized physicians. Initial patient characteristics may vary significantly in the groups for reasons that are unknown to date, greatly affecting treatment outcome.
authors.affiliation: University of Chicago and LithoLink Corp., Chicago, Illinois, USA.
authors.forename: F L
authors.initials: FL
authors.lastname: Coe
authors.forename: H
authors.initials: H
authors.lastname: Wise
authors.forename: J H
authors.initials: JH
authors.lastname: Parks
authors.forename: P J
authors.initials: PJ
authors.lastname: Fleury
authors.forename: J R
authors.initials: JR
authors.lastname: Asplin
mesh_terms: D002129:Calcium Oxalate / Q000652:urine; D002130:Calcium Phosphates; D006801:Humans; D008122:Local Area Networks; D015146:Midwestern United States; D009511:New England; D012307:Risk Factors; D014527:Uric Acid; D014545:Urinary Calculi / Q000517:prevention & control* / Q000628:therapy; D014556:Urine
chemical_list: D002130:Calcium Phosphates; C485828:alpha-tricalcium phosphate; C485830:tetracalcium phosphate; D002129:Calcium Oxalate; D014527:Uric Acid; C485838:calcium phosphate, monobasic, anhydrous; C020243:calcium phosphate; C485829:calcium phosphate, dibasic, anhydrous