METABOLIC EVALUATION AND SPECIFIC METAPHYLAXIS PROTOCOLS FOR UROLITHIASIS IN THE ERA OF ESWL

Abstract

Between October 1988 and January 1991, 200 stone patients (150 adults, 50 children) with an average age of 35.8 years underwent a uniformal metabolic evaluation program and specific metaphylaxis. 57.5% of the patients were recurrent stone formers with an average recurrence rate of 0.5. 43% of the patients showed a hypocitraturia, 23% a hypomagnesiuria. Hypercalcuria was found in 21% of the patients and hyperoxaluria in 10%. 8% of the patients were hyperuricosuric. There were no differences in the incidences of various aetiologic factors between first time stone formers and recurrent cases. The metaphylaxis was followed intermittently and was completed by a common sense diet. Patients with hypocitraturia and/or hypomagnesiuria received a deficiency grade adjusted oral augmentation with magnesiumhydroxide or natrium-potassium-citrate. Within an average follow up of 18 +/- 10.5 months no complications were seen, only four patients (3 adults and one child) developed recurrent stones (2%). The quotients calcium/citrate and calcium/magnesium were significantly lowered by the metaphylaxis and the new recurrence rate for the whole group was 0.018 at the end of the follow up. We suggest a metabolic evaluation of every stone patient and an individually programmed intermittent metaphylaxis, which would certainly help to optimize the success rate of ESWL therapy.