Metabolic evaluation and metaphylaxis in patients suffering from urolithiasis

The formation of urinary calculi has to be regarded as a symptom of a compl ex disease. Thus, in addition to stone removal prevention of stone regrowth and recurrence as well as purposeful metaphylaxis are required. Although a new era has begun with the introduction of extracorporeal shock wave litho tripsy - often leading to residual stone fragments - and although minimal i nvasive stone treatment has become possible, metaphylaxis is a factor that should not to be neglected. The metabolic evaluation of the individual stone patient forms the basis fo r recommendations as to the metaphylactic measures to be taken; their exten t is contingent on the stone composition. Since the nature of the urolith i s a decisive factor, its analysis is the most important step to be taken pr ior to any kind of metaphylactic treatment. In principle, the formation of urinary calculi has to be considered as a mu ltifactorial event, and it is therefore necessary to reveal renal malfuncti ons, disturbances in the transport or the composition of the urine by appro priate metabolic tests. On account of the frequency of the calcium oxalate stone disease, diagnosis of calcium metabolism is of particular importance here. For an efficient metaphylaxis in patients with solitary calcium oxala te stone occurrence it has proved sufficient to take the essential diagnost ic measures. However, as far as recurrent calcium oxalate urolithiasis is c oncerned extended diagnostics is required; functional tests may be necessar y. In patients suffering from uric acid-, cystine- or infection induced sto ne it has to be supposed that there are metabolic disorders underlying; it is therefore justifiable to make extended diagnostics. On account of the fact that most risk factors in urolithiasis relate to nut rition, appropriate change of nutrition has to be recommended as the essent ial metaphylactic measure. All other specific measures depend on the result s of the metabolic evaluation.