Tailored Kidney Stone Prevention Improves Metabolic Risk Factors and Reduces Renal Colic Rate.

Introduction: There is limited real-world data on the effectiveness of combined prophylactic measures to prevent recurrent kidney stone formation. Methods: This single-center retrospective study evaluated the effect of combined, patient-tailored prophylaxis on metabolic risk factors, urinary crystallization risk indices, and renal colic and urological intervention rates in a real-life clinical setting. Results: Four hundred ninety patients with nephrolithiasis (NL) with a median follow-up of 12.8 months were evaluated. After the introduction of prophylaxis, the main metabolic risk factors, namely urinary volume, oxalate, calcium, and citrate excretion improved significantly in patients presenting the specific risk factor at baseline (+ 653 ml/24 h for urinary volume, - 10.9 mg/24 h for oxaluria, - 2.35 mmol/24 h for calciuria, and + 901 μmol/24 h for citraturia; all P < 0.001). Relative urinary calcium oxalate supersaturation and Tiselius risk index improved significantly in the total population (- 1.68 and - 0.33, respectively; both P < 0.001). Renal colic and urological intervention rates improved significantly (from 0.82 to 0.21 /1000 d at risk, P < 0.001 for renal colic rate; and from 0.31 to 0.21 /1000 d at risk, P < 0.001 for urological intervention rate). A score expressing overall control of the 4 main metabolic risk factors was significantly associated with a reduction of renal colic rate during follow-up. Conclusion: Combined, patient-tailored prophylaxis in kidney stone formers significantly improves metabolic risk factors and urinary crystallization risk indices, resulting in a significant reduction of renal colic and urological intervention rates.