BJU international
October 20, 2026 · via Europe PMC
Does bespoke metabolic investigation reduce urinary stone recurrence? A narrative review.
Wiseman OJ, Turney BW.
AI summary — for doctors, generated from the abstract only
Targeted prevention that corrects a defined urinary abnormality reduces stone recurrence, and individualized metabolic workup is best supported in recurrent or high-risk stone formers.
What was studied
Narrative review of randomized trials, controlled cohorts, systematic reviews and guidelines (1980 to March 2026) on metabolic assessment, diet, drug therapy and recurrence, HRQOL and costs.
Key findings
- Higher fluid intake roughly halves recurrence (RR 0.45-0.55), and a calcium-normal, low-sodium, low-animal-protein diet gave RR 0.49 in hypercalciuric calcium oxalate formers.
- Potassium citrate (RR about 0.25), thiazides (0.52) and allopurinol (0.59) reduce recurrence, though the NOSTONE trial found no significant thiazide benefit.
- Evidence that 24-hour-urine-directed therapy beats empirical therapy is limited to high-risk patients.
Clinical relevance
It supports tailoring metabolic evaluation to recurrent, high-risk and post-procedural patients rather than testing everyone.
Who should care
Limitations
Narrative review without a described systematic selection process, so selection bias is possible, and several pooled estimates come from older or heterogeneous trials.
Offer 24-hour urine testing with targeted therapy and repeat testing to high-risk and recurrent stone formers, and give hydration and diet advice to all.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
Objective
To examine whether individualised ('bespoke') metabolic investigation and targeted dietary and medical therapy reduces urinary stone recurrence, and whether the approach also improves health-related quality of life (HRQOL) and lowers financial and environmental cost.
Methods
In this narrative review we searched PubMed/Medical Literature Analysis and Retrieval System Online (MEDLINE), the Cochrane Library and Europe PubMed Central (PMC) (January 1980 to March 2026) for randomised trials, controlled cohorts and systematic reviews on metabolic assessment and stone recurrence prevention in adults, supplemented by European Association of Urology (EAU), American Urological Association (AUA), National Institute for Health and Care Excellence (NICE) and American College of Physicians (ACP) guidance and by hand-searching of reference lists.
Results
Interventions that correct a defined urinary abnormality each reduce stone recurrence. Increased fluid intake approximately halves it (relative risk [RR] 0.45-0.55); a normal calcium, reduced sodium, reduced animal protein diet achieves a similar reduction in hypercalciuric calcium-oxalate formers (RR 0.49); and targeted pharmacotherapy lowers it further (potassium citrate RR approximately 0.25, thiazides 0.52, allopurinol 0.59), although the rigorous NOSTONE trial (ClinicalTrials.gov identifier: NCT03057431) found no significant thiazide benefit. After shockwave lithotripsy and percutaneous nephrolithotomy, medical therapy reduces stone formation and residual-fragment regrowth. Evidence that 24-h-urine-directed therapy outperforms empirical therapy is confined to high-risk patients, in whom selective treatment yields significantly fewer stone-related events. Stone disease impairs disease-specific quality of life and is costly, so preventing stone recurrence is cost-saving.
Conclusions
The case for bespoke prevention is strongest in recurrent, high-risk and post-procedural stone formers. Identifying the abnormality, correcting it, ensuring adherence and confirming the response by repeat testing offers the best chance to reduce stone recurrence and residual-stone growth, improve HRQOL, and lower financial cost.
DOI
10.1111/bju.70500
PMID
42901875
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
Want more like this?
Browse more from the feed. A free account unlocks the full feed, saving and communities.
Back to the research feed