Guidelines Followed for Assessment of Nephrolithiasis

May 27, 2011 (Washington, DC) — Urologists have a high rate of overall compliance with guidelines for the metabolic evaluation of stone disease, investigators reported here at the American Urological Association (AUA) 2011 Annual Scientific Meeting.

However, the study from the Vanderbilt University School of Medicine, in Nashville, Tennessee, also showed that urologists often fail to perform recommended testing for first-time stone formers who have risk factors for recurrent disease.

Davis P. Viprakasit, MD, a fellow in urologic surgery, presented the results of an international survey that examined urologists' compliance with guidelines on the metabolic evaluation of stone disease.

Nephrolithiasis is one of the most prevalent and debilitating diseases treated by urologists, and metabolic abnormalities have been documented in 68% to 90% of patients with stone disease, depending on the extent of testing, he explained. However, the initiation of preventive strategies, including dietary changes and medication therapy, is efficacious and cost effective in the medical management of stone disease.

On the basis of these observations, the National Institutes of Health, the European Association of Urology, and other urologic associations formulated guidelines for the metabolic evaluation of stone disease.

The Vanderbilt survey looked at 5 clinical cases developed from the guidelines that represented index patients with initial or recurrent stone disease. Survey participants were asked to choose options from the different evaluation strategies presented, including the use of common laboratory testing, stone analysis, and 24-hour urine studies.

Results from the 1307 AUA members, representing 68 countries, who completed the survey showed that urologists were compliant with guideline recommendations on 24-hour studies 82% to 85% of the time, depending on the particular scenario. However, testing for first-time stone formers with risk factors for recurrent disease, as recommended by the guidelines, was only performed by 54%.

Routine stone analysis was performed by 76% to 85% of urologists. Additionally, 70% to 81% ordered the guideline-recommended laboratory testing of serum calcium, uric acid, creatinine, and urinalysis.

Younger urologists, those who more recently completed their training, and urologists practicing in the United States were more likely to be compliant with the recommendations.

On the basis of their findings, the authors conclude that although the majority of those completing this international survey reported compliance with published guidelines, continued efforts should be made to highlight the importance of metabolic evaluations for stone prevention.

The study received no outside funding. Dr. Viprakasit has disclosed no relevant financial relationships.

American Urological Association (AUA) 2011 Annual Scientific Meeting: Abstract 69. Presented May 14, 2011.