Abstract
PurposeUrinary stone disease is a common disease with a prevalence of 4.7% in Germany. The incidence increased over the last decades, and recurrence rates are up to 50% in the first 5 years after diagnosis. Adequate preventive measures can avoid up to 46% of stone recurrences. These numbers outline the importance of prevention. Especially among high-risk stone formers, specific diagnostics and measures are required. Published data indicate the divergence between the importance of prevention and its implementation in everyday clinical practice. This is the first survey among German urological departments highlighting medical care concerning the prevention of recurrent urinary stone disease, identifying challenges and providing recommendations for improvements.MethodsTwo hundred and seventy urological hospital departments in Germany were anonymously surveyed about measurements to prevent recurrent stone disease. The questionnaire comprised 23 items dealing with diagnostics, counselling, knowledge among doctors concerning preventive measures and difficulties in preventing recurrent urinary stone disease.ResultsSixty-three urological departments (23.8%) answered the survey. The majority perform stone analysis at first and repeat events. Most patients with urinary stone disease receive general advice on preventive measures during their hospitalization. General recommendations focus on fluid intake and lifestyle changes. However, specific diets are infrequently recommended by inpatient urologists. Diagnostics to identify high-risk stone formers are mostly insufficient, and guideline-compliant urine tests are uncommon.ConclusionThe quality of secondary prevention needs to improve considerably. The focus should be put on identifying high-risk stone formers and offering those patients specific counselling. Furthermore, general advice on dietary recommendations should be extended.
Highlights
Urolithiasis is a common disease, 12% of the world's population suffers from urolithiasis once in a lifetime [1]
A model calculation from 2006 showed that adequate diagnostics and prevention could save the German health care system about 178 million Euros per year [9]. This German-wide survey aims to analyze the current state of medical care regarding the prevention of stones, outline major challenges and provide recommendations to improve medical care. This survey is a German-wide empirical analysis evaluating the state of medical care concerning recurrent stone disease prevention
In patients with a high risk of recurrence, the majority of treating urologists (38.1%) rarely request repeated urinary pH measurements, while 9.5% never do so, 14.3% occasionally do, 17.5% mostly do, and 20.6% always include them in their diagnostic pathway
Summary
Urolithiasis is a common disease, 12% of the world's population suffers from urolithiasis once in a lifetime [1]. Over the last few decades, an increase in the incidence and prevalence rates was observed [2]. A continuous upward trend is expected due to a change in nutrition, lifestyle and rising temperatures caused by climate change [3]. Nolde et al showed that preventive measures can reduce relapse in up to 46% of stone patients [6]. Most stone patients require basic preventive measures comprising recommendations on fluid intake, diet and lifestyle changes. The German and European guidelines define groups at low and high risk for stone recurrence. About one quarter of patients has a high-risk profile. For high-risk stone formers, specific measures need to be taken to prevent a recurrence
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