Clinical investigations from the RACP

The patient with a urinary calculus: what to do next

Duncan Cooke, Stephen McDonald
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The purpose of investigating patients with urinary stones is primarily to prevent stone recurrence. In the case of asymptomatic stones, the aim is to prevent these stones from causing problems such as obstruction or infection.

Key Points

  • Urinary stones are a common problem. They are frequently symptomatic and costly in terms of hospital presentations, investigations and treatment.
  • Approximately 80% of urinary stones are calcium stones.
  • Noncontrast CT scanning in the best imaging modality for urinary stones.
  • Stones should be retrieved for composition analysis.
  • Extensive metabolic assessment is only required for patients who are recurrent stone formers.
  • All patients should be encouraged to drink more than 3 litres of water daily. Most patients who form stones are also likely to benefit from dietary changes.