Prophylaxis of Recurrent Stone Disease in Outpatient Clinics in Germany: A Quality-of-Care Concern

Abstract

Introduction: The aim of the study was to survey current practices for preventing recurrent stone disease in an outpatient clinic setting in Germany. Methods: Two invitations to complete an anonymous REDCap® survey were emailed to members of the occupational union of German urologists who work as outpatient urologists (“Berufsverband Deutscher Urologen e.V.”). The survey included questions on diagnostic modalities and counselling to prevent stone disease. Results: A total of 130 outpatient urologists completed the survey. 84.6% of urologists give general advice to first-time stone formers. Recommendations comprise increased fluid uptake in 100%, two-thirds advice on calcium and oxalate intake, and one-third on salt and protein intake. 64.6% perform a metabolic evaluation for high-risk stone formers. However, patients with risk factors other than repeat stone disease are often overlooked. Urologists agreed that a lack of time (73.1%) and reimbursement (64.6%), as well as insufficient patient compliance (60.8%), pose significant challenges. The majority of urologists agreed that training is required. Conclusion: General recommendations for stone formers are usually provided, but nutritional advice tends to be incomplete. Our results raise quality-of-care concerns: Metabolic evaluation of stone formers at high risk of recurrence is uncommon. Structural changes are required due to time constraints, and poor remuneration must be addressed to improve patient care.