Skip to main content

Advertisement

SpringerLink
Log in

Attitudes of urologists on metabolic evaluation for urolithiasis: outcomes of a global survey from 57 countries

  • Original Article
  • Published:
Urolithiasis Aims and scope Submit manuscript

Abstract

Although stone disease is an important health problem with high incidence and recurrence rates, it is a preventable disease. Attitudes and practices of urologists regarding the prevention of recurrence continue to be a subject of debate. In this context, an online survey study was conducted involving 305 urologists from 57 different countries. The first 7 questions collected demographic data about the urologists and the remaining 23 questions were about the recurrence and metabolic evaluation, medical treatment, and follow-up of urinary stone disease. Most urologists (85.2%) thought that metabolic examination was important. Approximately one-third of the participants (34.1%) performed 24-hour urine analysis and stone analysis was ordered by 87.5% of the urologists. Metabolic analysis was performed for all patients by 14.7% of the participants. For pediatric patients this rate was 68.5%, and for adults with recurrence the rate was 81.6%. Reasons cited by the urologists for not performing metabolic analysis included not feeling confident doing so (18.3%), having limited facilities in their hospital (26.5%), having an excessive daily workload (31.8%), patient-related factors (27.5%), and referring patients to other departments for metabolic evaluation (20.9%). Although majority of the responding urologists do consider the metabolic analysis as vital important, they seemed not to be willing to perform these tests with the same degree of enthusiasm in their daily practice. Our results show that urologists need support in performing and interpreting 24-hour urine analysis, improving their knowledge levels, and communicating with patients. Urology residency training should focus more on the prevention of urinary stone recurrence in addition to the surgical training.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Ghani KR, Sammon JD, Karakiewicz PI, Sun M, Bhojani N, Sukumar S, Peabody JO, Menon M, Trinh QD (2013) Trends in surgery for upper urinary tract calculi in the USA using the Nationwide Inpatient Sample: 1999–2009. BJU Int 112(2):224–230. https://doi.org/10.1111/bju.12059

    Article  PubMed  Google Scholar 

  2. Scales CD, SmithHanley ACJM Jr, Saigal CS, Urologic Diseases in America Project (2012) Prevalence of kidney stones in the United States. Eur Urol 62(1):160–165. https://doi.org/10.1016/j.eururo.2012.03.052

    Article  PubMed  PubMed Central  Google Scholar 

  3. Strohmaier WL (2000) Course of calcium stone disease without treatment. What can we expect? Eur Urol 37(3):339–344

    Article  CAS  Google Scholar 

  4. Antonelli JA, Maalouf NM, Pearle MS, Lotan Y (2014) Use of the national health and nutrition examination survey to calculate the impact of obesity and diabetes on cost and prevalence of urolithiasis in 2030. Eur Urol 66(4):724–729. https://doi.org/10.1016/j.eururo.2014.06.036

    Article  PubMed  PubMed Central  Google Scholar 

  5. Lotan Y, Cadeddu JA, Roerhborn CG, Pak CY, Pearle MS (2004) Cost-effectiveness of medical management strategies for nephrolithiasis. J Urol 172(6 Pt 1):2275–2281. https://doi.org/10.1097/01.ju.0000141498.11720.20

    Article  PubMed  Google Scholar 

  6. Fink HA, Akornor JW, Garimella PS, MacDonald R, Cutting A, Rutks IR, Monga M, Wilt TJ (2009) Diet, fluid, or supplements for secondary prevention of nephrolithiasis: a systematic review and meta-analysis of randomized trials. Eur Urol 56(1):72–80. https://doi.org/10.1016/j.eururo.2009.03.031

    Article  PubMed  PubMed Central  Google Scholar 

  7. Türk C, Petřík A, Sarica K, Seitz C, Skolarikos A, Straub M, Knoll T (2016) EAU guidelines on diagnosis and conservative management of Urolithiasis. Eur Urol 69(3):468–474. https://doi.org/10.1016/j.eururo.2015.07.040

    Article  PubMed  Google Scholar 

  8. Pearle MS, Goldfarb DS, Assimos DG, Curhan G, Denu-Ciocca CJ, Matlaga BR, Monga M, Penniston KL, Preminger GM, Turk TM, White JR, Assocation AU (2014) Medical management of kidney stones: AUA guideline. J Urol 192(2):316–324. https://doi.org/10.1016/j.juro.2014.05.006

    Article  PubMed  Google Scholar 

  9. Daga S, Palit V, Forster JA, Biyani CS, Joyce AD, Dimitrova AB (2021) An update on evaluation and management in Cystinuria. Urology 149:70–75. https://doi.org/10.1016/j.urology.2020.12.025

    Article  PubMed  Google Scholar 

  10. Leanez Jiménez M, Candau Vargas-Zúñiga F, Reina Ruiz C (2017) La litiasis urinaria como enfermedad sistémica [Urinary lithiasis as a systemic disease.]. Arch Esp Urol 70(1):28–39

    PubMed  Google Scholar 

  11. Magni G, Unwin RJ, Moochhala SH (2021) Renal tubular acidosis (RTA) and kidney stones: Diagnosis and management. Acidosis tubular renal (ATR) y litiasis renal: Diagnóstico y manejo. Arch Esp Urol 74(1):123–128

    PubMed  Google Scholar 

  12. Milose JC, Kaufman SR, Hollenbeck BK, Wolf JS Jr, Hollingsworth JM (2014) Prevalence of 24-hour urine collection in high risk stone formers. J Urol 191(2):376–380. https://doi.org/10.1016/j.juro.2013.08.080

    Article  PubMed  Google Scholar 

  13. Harmouch SS, Abou-Haidar H, Elhawary H, Grgic T, Lantz AG, Lee JY, Chew BH, Andonian S, Bhojani N (2018) Metabolic evaluation guidelines in patients with nephrolithiasis: Are they being followed? Results of a national, multi-institutional, quality-assessment study. Can Urol Asso J 12(10):313–318. https://doi.org/10.5489/cuaj.5155

    Article  Google Scholar 

  14. McGuire BB, Matulewicz RS, Zuccarino-Crowe R, Nadler RB, Perry KT (2016) Contemporary attitudes and practice patterns of north american urologists in investigating stone-forming patients-A Survey of Endourological Society Members. J Endourol 30(4):460–464. https://doi.org/10.1089/end.2015.0207

    Article  PubMed  Google Scholar 

  15. Hsi RS, Stoller ML (2017) Complete metabolic evaluation is indicated after a first stone event: Con. J Urol 197(3 Pt 1):545–547. https://doi.org/10.1016/j.juro.2016.12.028

    Article  PubMed  Google Scholar 

  16. Eysenbach G (2004) Improving the quality of Web surveys: the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). J Med Internet Res 6(3):e34. https://doi.org/10.2196/jmir.6.3.e34

    Article  PubMed  PubMed Central  Google Scholar 

  17. Hyams ES, Matlaga BR (2014) Economic impact of urinary stones. Translat Androl Urol 3(3):278–283. https://doi.org/10.3978/j.issn.2223-4683.2014.07.02

    Article  Google Scholar 

  18. Raheem OA, Khandwala YS, Sur RL, Ghani KR, Denstedt JD (2017) Burden of urolithiasis: trends in prevalence, treatments, and costs. Eur Urol Focus 3(1):18–26. https://doi.org/10.1016/j.euf.2017.04.001

    Article  PubMed  Google Scholar 

  19. Curhan GC (2007) Epidemiology of stone disease. Urol Clinics N Am 34(3):287–293. https://doi.org/10.1016/j.ucl.2007.04.003

    Article  Google Scholar 

  20. Yagisawa T, Chandhoke PS, Fan J (1999) Comparison of comprehensive and limited metabolic evaluations in the treatment of patients with recurrent calcium urolithiasis. J Urol 161(5):1449–1452

    Article  CAS  Google Scholar 

  21. Heilberg IP (2000) Update on dietary recommendations and medical treatment of renal stone disease. Nephrol Dial Transpl 15(1):117–123. https://doi.org/10.1093/ndt/15.1.117

    Article  CAS  Google Scholar 

  22. Bandi G, Nakada SY, Penniston KL (2008) Practical approach to metabolic evaluation and treatment of the recurrent stone patient. WMJ 107(2):91–100

    PubMed  Google Scholar 

  23. Gambaro G, Croppi E, Coe F, Lingeman J, Moe O, Worcester E, Buchholz N, Bushinsky D, Curhan GC, Ferraro PM, Fuster D, Goldfarb DS, Heilberg IP, Hess B, Lieske J, Marangella M, Milliner D, Preminger GM, Reis Santos JM, Sakhaee K, Consensus Conference Group (2016) Metabolic diagnosis and medical prevention of calcium nephrolithiasis and its systemic manifestations: a consensus statement. J Nephrol 29(6):715–734. https://doi.org/10.1007/s40620-016-0329-y

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Grampsas SA, Moore M, Chandhoke PS (2000) 10-year experience with extracorporeal shockwave lithotripsy in the state of Colorado. J Endourol 14(9):711–714. https://doi.org/10.1089/end.2000.14.711

    Article  CAS  PubMed  Google Scholar 

  25. Hess B, Hasler-Strub U, Ackermann D, Jaeger P (1997) Metabolic evaluation of patients with recurrent idiopathic calcium nephrolithiasis. Nephrol Dial Transpl 12(7):1362–1368. https://doi.org/10.1093/ndt/12.7.1362

    Article  CAS  Google Scholar 

  26. Norman RW, Bath SS, Robertson WG, Peacock M (1984) When should patients with symptomatic urinary stone disease be evaluated metabolically? J Urol 132(6):1137–1139. https://doi.org/10.1016/s0022-5347(17)50064-6

    Article  CAS  PubMed  Google Scholar 

  27. Tiselius HG, Daudon M, Thomas K, Seitz C (2017) Metabolic work-up of patients with urolithiasis: indications and diagnostic algorithm. Eur Urol Focus 3(1):62–71. https://doi.org/10.1016/j.euf.2017.03.014

    Article  PubMed  Google Scholar 

  28. Corder CJ, Rathi BM, Sharif S, Leslie SW (2021) 24-Hour Urine Collection. StatPearls Publishing, In StatPearls

    Google Scholar 

  29. Vahlensieck EW, Bach D, Hesse A (1982) Circadian rhythm of lithogenic substances in the urine. Urol Res 10(4):195–203. https://doi.org/10.1007/BF00255944

    Article  CAS  PubMed  Google Scholar 

  30. Ahlstrand C, Tiselius HG, Larsson L (1984) Diurnal variation of urine composition in calcium oxalate stone disease during treatment with bendroflumethiazide. Eur Urol 10(4):260–265. https://doi.org/10.1159/000463804

    Article  CAS  PubMed  Google Scholar 

  31. Tiselius HG (2015) Should we modify the principles of risk evaluation and recurrence preventive treatment of patients with calcium oxalate stone disease in view of the etiologic importance of calcium phosphate? Urolithiasis 43(Suppl 1):47–57. https://doi.org/10.1007/s00240-014-0698-4

    Article  PubMed  Google Scholar 

  32. Kocvara R, Plasgura P, Petrík A, Louzenský G, Bartonícková K, Dvorácek J (1999) A prospective study of nonmedical prophylaxis after a first kidney stone. BJU Int 84(4):393–398. https://doi.org/10.1046/j.1464-410x.1999.00216.x

    Article  CAS  PubMed  Google Scholar 

  33. Curhan GC, Willett WC, Rimm EB, Stampfer MJ (1993) A prospective study of dietary calcium and other nutrients and the risk of symptomatic kidney stones. N Engl J Med 328(12):833–838. https://doi.org/10.1056/NEJM199303253281203

    Article  CAS  PubMed  Google Scholar 

  34. Curhan GC, Willett WC, Speizer FE, Spiegelman D, Stampfer MJ (1997) Comparison of dietary calcium with supplemental calcium and other nutrients as factors affecting the risk for kidney stones in women. Ann Intern Med 126(7):497–504. https://doi.org/10.7326/0003-4819-126-7-199704010-00001

    Article  CAS  PubMed  Google Scholar 

  35. Robertson WG (2016) Dietary recommendations and treatment of patients with recurrent idiopathic calcium stone disease. Urolithiasis 44(1):9–26. https://doi.org/10.1007/s00240-015-0849-2

    Article  CAS  PubMed  Google Scholar 

  36. Park S, Pearle MS (2005) Urolithiasis: update on metabolic evaluation of stone formers. Sci World J 5:902–914. https://doi.org/10.1100/tsw.2005.118

    Article  CAS  Google Scholar 

  37. Carvalho M, Erbano BO, Kuwaki EY, Pontes HP, Liu J, Boros LH, Asinelli MO, Baena CP (2017) Effect of potassium citrate supplement on stone recurrence before or after lithotripsy: systematic review and meta-analysis. Urolithiasis 45(5):449–455. https://doi.org/10.1007/s00240-016-0950-1

    Article  CAS  PubMed  Google Scholar 

  38. Pak CY, Poindexter JR, Adams-Huet B, Pearle MS (2003) Predictive value of kidney stone composition in the detection of metabolic abnormalities. Am J Med 115(1):26–32. https://doi.org/10.1016/s0002-9343(03)00201-8

    Article  CAS  PubMed  Google Scholar 

  39. Hesse A, Kruse R, Geilenkeuser WJ, Schmidt M (2005) Quality control in urinary stone analysis: results of 44 ring trials (1980–2001). Clin Chem Lab Med 43(3):298–303. https://doi.org/10.1515/CCLM.2005.051

    Article  CAS  PubMed  Google Scholar 

  40. Gilad R, Williams JC Jr, Usman KD, Holland R, Golan S, Tor R, Lifshitz D (2017) Interpreting the results of chemical stone analysis in the era of modern stone analysis techniques. J Nephrol 30(1):135–140. https://doi.org/10.1007/s40620-016-0274-9

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Urology, Health Sciences University, Prof. Dr. Cemil Taşcıoğlu City Hospital, Istanbul, Turkey

    Mehmet Ali Karagöz

  2. Department of Urology, Meram Medical Faculty, Necmettin Erbakan University, Konya, Turkey

    Selçuk Güven

  3. Department of Urology, İstanbul University İstanbul School of Medicine, Istanbul, Turkey

    Tzevat Tefik

  4. Department of Urology, Faculty of Medicine, Ankara University, Ankara, Turkey

    Mehmet İlker Gökçe

  5. Department of Urology, Koc University Hospital, Istanbul, Turkey

    Murat Can Kiremit

  6. Department of Urology, Başakşehir Çam Ve Sakura City Hospital, Istanbul, Turkey

    Feyzi Arda Atar

  7. Department of Urology, Keçiören Training and Research Hospital, Ankara, Turkey

    Muhammed Arif İbiş

  8. Depatment of Urology, Faculty of Medicine, Istinye University, Istanbul, Turkey

    Yasin Yitgin

  9. Department of Urology, Medivita İncirli Hospital, Istanbul, Turkey

    Abubekir Böyük

  10. Department of Urology, Van Training and Research Hospital, Van, Turkey

    Samed Verep

  11. Department of Urology, Biruni University Medical School, Medicana Bahçelievler Hospital, Istanbul, Turkey

    Kemal Sarıca

Authors
  1. Mehmet Ali Karagöz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Selçuk Güven
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tzevat Tefik
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mehmet İlker Gökçe
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Murat Can Kiremit
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Feyzi Arda Atar
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Muhammed Arif İbiş
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Yasin Yitgin
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Abubekir Böyük
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Samed Verep
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Kemal Sarıca
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

M.A.K and KS study conception and design. M.A.K., A.I, Y.Y., A.B., K.S., S.G., M.I.G. and T.T. preparation of the survey. M.C.K. A.A. and S.V. preparation of the tables and figures. All authors reviewed the manuscript.

Corresponding author

Correspondence to Mehmet Ali Karagöz.

Ethics declarations

Conflict of interest

The authors declare no conflict of interest.

Ethical approval

This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent was obtained from all of the participants that were included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Karagöz, M.A., Güven, S., Tefik, T. et al. Attitudes of urologists on metabolic evaluation for urolithiasis: outcomes of a global survey from 57 countries. Urolithiasis 50, 711–720 (2022). https://doi.org/10.1007/s00240-022-01362-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00240-022-01362-x

Keywords

Search

Navigation