title: Metabolic evaluation and recurrence prevention for urinary stone patients: EAU guidelines.
abstract: BACKGROUND
  An optimum metabolic evaluation strategy for urinary stone patients has not been clearly defined.
  
  
  OBJECTIVE
  To evaluate the optimum strategy for metabolic stone evaluation and management to prevent recurrent urinary stones.
  
  
  METHODS
  Several databases were searched to identify studies on the metabolic evaluation and prevention of stone recurrence in urolithiasis patients. Special interest was given to the level of evidence in the existing literature.
  
  
  RESULTS
  Reliable stone analysis and basic metabolic evaluation are highly recommended in all patients after stone passage (grade A). Every patient should be assigned to a low- or high-risk group for stone formation. It is highly recommended that low-risk stone formers follow general fluid and nutritional intake guidelines, as well as lifestyle-related preventative measures to reduce stone recurrences (grade A). High-risk stone formers should undergo specific metabolic evaluation with 24-h urine collection (grade A). More specifically, there is strong evidence to recommend pharmacological treatment of calcium oxalate stones in patients with specific abnormalities in urine composition (grades A and B). Treatment of calcium phosphate stones using thiazides is only highly recommended when hypercalciuria is present (grade A). In the presence of renal tubular acidosis (RTA), potassium citrate and/or thiazide are highly recommended based on the relative urinary risk factor (grade A or B). Recommendations for therapeutic measures for the remaining stone types are based on low evidence (grade C or B following panel consensus). Diagnostic and therapeutic algorithms are presented for all stone types based on the best level of existing evidence.
  
  
  CONCLUSIONS
  Metabolic stone evaluation is highly recommended to prevent stone recurrences.
  
  
  RESULTS
  In this report, we looked at how patients with urolithiasis should be evaluated and treated in order to prevent new stone formation. Stone type determination and specific blood and urine analysis are needed to guide patient treatment.
authors.affiliation: Second Department of Urology, Sismanoglio Hospital, Athens Medical School, Athens, Greece. Electronic address: andskol@yahoo.com.
authors.forename: Andreas
authors.initials: A
authors.lastname: Skolarikos
authors.affiliation: Department of Urology, Technical University Munich, Munich, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Straub
authors.affiliation: Department of Urology, Sindelfingen-Boeblingen Medical Center, University of Tübingen, Sindelfingen, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Knoll
authors.affiliation: Department of Urology, Dr Lutfi Kırdar Research and Teaching Hospital, Istanbul, Turkey.
authors.forename: Kemal
authors.initials: K
authors.lastname: Sarica
authors.affiliation: Department of Urology, Medical University Vienna, Austria.
authors.forename: Christian
authors.initials: C
authors.lastname: Seitz
authors.affiliation: Department of Urology, Region Hospital, České Budějovice, Czech Republic; Department of Urology, Charles University, 1st Faculty of Medicine, Prague, Czech Republic.
authors.forename: Ales
authors.initials: A
authors.lastname: Petřík
authors.affiliation: Department of Urology, Rudolfstiftung Hospital, Vienna, Austria.
authors.forename: Christian
authors.initials: C
authors.lastname: Türk
mesh_terms: D000141:Acidosis, Renal Tubular / Q000150:complications; D000328:Adult; D000368:Aged; D002118:Calcium / Q000652:urine*; D017610:Calcium Compounds / Q000378:metabolism / Q000652:urine*; D002129:Calcium Oxalate / Q000652:urine; D002130:Calcium Phosphates / Q000652:urine; D004326:Drinking; D005260:Female; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012307:Risk Factors; D014545:Urinary Calculi / Q000209:etiology* / Q000378:metabolism / Q000517:prevention & control* / Q000628:therapy / Q000652:urine
chemical_list: D017610:Calcium Compounds; D002130:Calcium Phosphates; D002129:Calcium Oxalate; D002118:Calcium
keywords: European Association of Urology; Guidelines; Lithiasis; Medical treatment; Metabolic evaluation; Recurrence and conservative treatment; Stone; Urinary