Appropriate metabolic evaluation and subsequent management is a keystone of urolithiasis treatment and stone recurrence risk reduction. The EAU guidelines currently recommend full metabolic evaluation in high-risk stone formers. However, practices in terms of metabolic evaluation and metabolic management vary widely globally, thus raising the risk of stone recurrence. To assess current practice among urologists in terms of metabolic analysis and management following surgery for stone disease in different countries.
A Google Forms survey including 14 closed questions was circulated to urologists and residents worldwide via research group networks. Information was collected regarding baseline demographics as well as current practices in metabolic evaluation. Descriptive statistics were used to describe respondents' characteristics.
Overall, a total of 253 respondents participated worldwide, with 81% from Europe. In total, 56% were aged 30-39 years old and 37% declared a subspecialty interest in Endourology. Overall, 12% of the surveyed urologists never request a metabolic evaluation for their patients after surgery, whereas 51% reserve full metabolic evaluation only for high-risk stone formers, and 37% perform full metabolic analysis for each patient after surgery. Two respondents out of 3 routinely and autonomously interpret results, and 37% personally manage any metabolic abnormalities. The vast majority of respondents (89%) personally recommend general preventive measures to avoid stone recurrences, and 64% would routinely prescribe alkalinization treatment when indicated.
Despite the majority of respondents organizing full metabolic evaluation for their patients, only two out of three urologists are able to interpret results, and only one out of three personally manages any abnormalities detected. Moreover, a non-negligible percentage of urologists do not ask for metabolic evaluation at all. These results underscore the need for multidisciplinary management of patients with urolithiasis with nephrologist input, particularly in cases where a urologist may not have the necessary subspecialty expertise to manage complex metabolic stone disease.
The French journal of urology. 2026 May 06 [Epub ahead of print]
Luigi Candela, Aideen Madden, Letizia Maria Ippolita Jannello, Alejandra Bravo-Balado, Stefano Moretto, Marie Chicaud, Carlos Altez Fernandez, Federico Zorzi, Alberto Quara, Stessy Kutchukian, Marielou Letouche, Jorge Peña Lueza, Razvan-Ionut Popescu, Olivier Traxer
Urology Service, Tenon Hospital, Sorbonne University, Paris, France; Progress and Collaboration in Endourology (PACE) Group, Paris, France. Electronic address: ., Progress and Collaboration in Endourology (PACE) Group, Paris, France; Department of Urology, Mercy University Hospital, Cork, Ireland., Progress and Collaboration in Endourology (PACE) Group, Paris, France; Unit of Urology, Department of Health Sciences, University of Milan, Milan, Italy., Urology Service, Tenon Hospital, Sorbonne University, Paris, France; Progress and Collaboration in Endourology (PACE) Group, Paris, France., Urology Service, Tenon Hospital, Sorbonne University, Paris, France; Progress and Collaboration in Endourology (PACE) Group, Paris, France; Department of Urology, Humanitas Clinical and Research Institute IRCSS, Milan, Italy., Progress and Collaboration in Endourology (PACE) Group, Paris, France; Urology Service, CHU Limoges, Limoges, France., Progress and Collaboration in Endourology (PACE) Group, Paris, France; Urology Service, Hospital Universitario A Coruna, Spain., Urology Service, Tenon Hospital, Sorbonne University, Paris, France; Progress and Collaboration in Endourology (PACE) Group, Paris, France; Department of Urology, University of Trieste, Trieste, Italy., Progress and Collaboration in Endourology (PACE) Group, Paris, France; Division of Urology, San Luigi Gonzaga Hospital, Turin, Italy., Progress and Collaboration in Endourology (PACE) Group, Paris, France; Poitiers University Hospital, France., Progress and Collaboration in Endourology (PACE) Group, Paris, France; University Hospital of Tours, France., Progress and Collaboration in Endourology (PACE) Group, Paris, France; Urology Service, Tenon Hospital, Sorbonne University, Paris, France., Progress and Collaboration in Endourology (PACE) Group, Paris, France; Carol Davila University of Medicine and Pharmacy, Faculty of Medicine, Urology Department, "Prof. Dr. Th. Burghele" Clinical Hospital, 061344 Bucharest, Romania.