Update – 2022 Canadian Urological Association guideline: Evaluation and medical management of the kidney stone patient

Abstract

Introduction Despite advances in the surgical management of urinary stone disease that have significantly reduced patient morbidity, new stone formation and recurrence remain significant health issues. Data from the United States National Health and Nutrition Examination Survey (NHANES) published in 2020 reported a kidney stone prevalence of 12% in men and 10% among women. 1 Recent data from the US also has noted a cumulative increase in stone incidence from 0.6% to 0.9% between 2005 and 2015. 2 An increase in stone formation among women has also been observed such that the male to female ratio appears to be decreasing. 3,4 Evidence is also emerging there may be an increase in the incidence of certain stone compositions such as uric acid, a stone type linked to both dietary and metabolic risk factors. 5 Furthermore, the association with obesity, metabolic syndrome, diabetes mellitus and stone formation suggests nephrolithiasis should be regarded as a systemic disease. Recurrence rates after an initial symptomatic stone event are reported to be 30-50% within 10 years. 6,7 Therefore, patients are generally motivated to explore prevention strategies. 1 96.8% of recurrent stone formers or those with more than one concurrent stone will have a urinary metabolic abnormality. 8 Epidemiological data from the US show that only 7% of patients