Evaluation of the recurrent stone former

At one time, metabolic kidney stone disease was evaluated and treated primarily by endocrinologists and nephrologists. Until the 1980s, stone clinics were commonplace in academic settings where a team of internists and urologists would see patients together to sort out the evaluation and set up a treatment plan for the recurrent stone former. With the introduction of extracorporeal shock wave lithotripsy (SWL) about 25 years ago, a dramatic change took place in the clinical practice of kidney stone prevention. As the morbidity of SWL is low and the treatment can be performed on an outpatient basis, many urologists feel that it is more practical to treat the offending recurrent stone rather than undergo a complex metabolic evaluation and a rigorous treatment plan to prevent future stone episodes. This rationale may be applicable to the first-time or occasional recurrent stone former, such as a patient who forms new stones less frequently than once every 5 years. However, for the more frequent stone formers, and even for some first-time stone formers interested in preventing future episodes of renal colic, a metabolic evaluation is necessary. Medical management of urolithiasis is now within the clinical domain of the urologist. The urologist, rather than members of other medical specialties, seems to have the primary responsibility of the medical management of stone disease. Thus, it is essential for the urologist to have a good working knowledge of the principles of metabolic evaluation and kidney stone prevention.