Sorbonne Université, Service d'Urologie, AP-HP.
Sorbonne Université, GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Paris, France.
Curr Opin Urol. 2019 Jan;29(1):52-64. doi: 10.1097/MOU.0000000000000562.
To summarize recommendations of the guidelines of the American Urological Association and European Association of Urology, and our opinion on which urinary tract stone disease patients should be metabolically evaluated at which moment and how often.
A standard metabolic evaluation should be performed in all stone formers to prevent recurrent disease. This includes a medical and lifestyle history, physical examination, basic urine and blood analysis, radiological examination and stone analysis. The latter should already be performed during surgery, especially when only a couple of fragments are sent for analysis. Supplementary, performing a 24-h urine analysis should be supported in all patients to understand the lithogenic process that will guide the according follow-up. When risk factors are found, an extended individualized metabolic evaluation should be performed to exclude underlying metabolic diseases and to start stone-specific recurrence prevention.
Urologists should be trained in perioperative stone characterization, because it contains information of urinary environment at the times of stone formation and growth. The extensiveness and frequency of metabolic work-up and follow-up of stone formers should be tailored to the type of stone, severity of the disease, patient's comorbidities and medications.
总结美国泌尿外科学会和欧洲泌尿外科学会指南的建议，以及我们关于哪些尿路结石病患者应在何时及多久进行代谢评估的意见。
应对所有结石形成者进行标准代谢评估，以预防疾病复发。这包括病史和生活方式、体格检查、基本尿液和血液分析、影像学检查和结石分析。后者应在手术期间进行，尤其是当只送几个碎片进行分析时。此外，应支持所有患者进行 24 小时尿液分析，以了解结石形成过程，从而指导相应的随访。当发现危险因素时，应进行扩展的个体化代谢评估，以排除潜在的代谢疾病，并开始针对结石的复发预防。
泌尿科医生应接受围手术期结石特征描述的培训，因为它包含了结石形成和生长时尿液环境的信息。结石形成者的代谢评估的广度和频率以及随访应根据结石的类型、疾病的严重程度、患者的合并症和药物来定制。
