Téma: 

Indication and performance of metabolic examination of urolithiasis

Roman Sobotka, Tomáš Hanuš, Květoslav Novák, Radim Kočvara

Objective: The article deals with the identification of patients at risk of a higher rate of recurrence of lithiasis and the creation of risk groups in which everyone with diagnosed stone disease should be included. It is also discussed an extended range of basic metabolic tests and their indications. The second part of the article is focused on implementing a range of metabolic tests in individual metabolic disturbances leading to the formation of lithiasis. Methods: The article is based on a summary of recent literature in the last 10 years, using Medline, to fit the modern view of screening and prevention of recurrent urolithiasis. The article is in line with the EAU Guidelines. Results: How to look at creating lithiasis and recurrent urolithiasis testing methodology over the last decade has changed, especially in patients with calcium lithiasis. In these patients will be sufficient only to proof the hypercalciuria alone. Similarly, there has been somewhat different view of uric acid lithiasis treatment. The article has the main objective in a summary procedure, how to treat a patient who presented with lithiasis, the integration of individuals into risk groups and indicate where and how to make the metabolic examination. Conclusion: Urolithiasis is a serious medical and economic problem throughout life, affecting up to 10 % of the population. After surgical treatment approximately 35 % of depressed patients relapse within 5 years, 50 % of patients over 10 years. Detailed metabolic examination is indicated in selected patients with moderate risk and at high risk of relapse and for all pediatric patients with the occurrence of lithiasis. Some metabolic abnormalities with this kind of examination identify nearly 90 % of subjects. By following this procedure we are able to identify most patients at high risk of recurrence who may benefit from metafylaxe and to distinguish patients with only sporadic occurrence of lithiasis, in which the cost of testing exceeds the yield results. Education of patients on general principles and use metaphylactic drug therapy in indicated cases reduces the likelihood of relapse by up to 90 %, reduces the morbidity of these patients while reducing the economic cost of repeated surgical treatment of lithiasis.

Ročník 2010  Témy časopisu Clinical urology 2 / 2010

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