Metabolic evaluation of stone disease patients: A practical approach

In the last three decades, minimally invasive techniques have progressed si gnificantly, replacing traditional open surgery as the mainstay of stone di sease surgical treatment. The challenge for the next millennium remains med ical prevention of calcium urolithiasis, a field where less dramatic progre ss has been achieved during the same period of time. The purpose of this ar ticle is to provide the practicing urologist with current practical guideli nes for the assessment and management of calcium urolithiasis patients. The recommendations are based on the latest available information regarding th e pathogenesis, medical treatment options, and decision-making rationale wh en managing these challenging patients. Every urolithiasis patient should u ndergo a basic evaluation, which is considered the minimal essential diagno stic work-up, in order to rule out obvious, treatable systemic causes of ur inary stone disease. All patients should be advised about conservative nons pecific preventive measures. High-risk stone patients should have a more ex tensive metabolic evaluation based on two 24-hour urine samples. Treatment protocols for each patient are tailored individually according to the metab olic evaluation findings.