Urolithiasis is increasingly common, with rising rates driven by obesity, diabetes and metabolic syndrome. Patients with cancer have additional, unique risks of stone formation owing to effects on fluid and electrolyte balance, systemic cancer therapies, tumour lysis syndrome and anatomical alterations after urinary diversion or nephrectomy. Moreover, urolithiasis itself has been linked to increased rates of renal cell carcinoma, urothelial carcinoma and bladder cancer, potentially mediated by chronic inflammation, recurrent infections and shared metabolic or environmental factors. Management in this setting is complex and must be individualized. Percutaneous nephrolithotomy achieves the highest stone-free rates in patients with altered urinary tract anatomy, whereas retrograde intrarenal surgery and shock wave lithotripsy have more selective roles. Preventive strategies focus on thorough metabolic evaluation, hydration optimization and addressing cancer-specific risk factors such as hypercalcaemia, acidosis and chronic urinary stasis. Despite these insights, data on the epidemiology, mechanistic underpinnings and optimal management of urolithiasis in patients with cancer remain limited. Prospective studies are needed to clarify causal relationships, refine preventive strategies and develop evidence-based treatment algorithms for this growing and complex population.
Nature reviews. Urology. 2026 Jun 22 [Epub ahead of print]
Priya Dave, Amy Yau, A Ari Hakimi, Mantu Gupta, William Atallah, Alexander C Small, Kavita Gupta, Douglas S Scherr, David S Goldfarb, Aisha Shaikh
Department of Urology, Montefiore Medical Center, Bronx, NY, USA., Department of Medicine, Wexner Medical Center, Columbus, OH, USA., Department of Urology, Memorial Sloan Kettering Cancer Center, New York, NY, USA., Department of Urology, Mount Sinai Hospital, New York, NY, USA., Department of Urology, Weill Cornell Medicine, New York, NY, USA., Department of Medicine, New York Langone Medical Center, New York, NY, USA., Department of Urology, Memorial Sloan Kettering Cancer Center, New York, NY, USA. .