Medical Treatment: Worthwhile and When?

The incidence of nephrolithiasis in industrialized countries is 0.5% to 1% annually. Stone formers subsequently face recurrence rates of 50% over 5 years. Annual costs in the United States for evaluation and treatment have been estimated at $1.83 billion USD [Clark JY, Thompson IM, Optenburg SA. Economic impact of urolithiasis in the United States. J Urol 1995;154:2020-2024]. Clearly the impact of urinary stone management poses an ever increasing medical, economic and social burden to modern society. The ability to detect 97% of underlying medical abnormalities in stone forming patients has stimulated discoveries of both selective and non-selective medical therapies to prevent stone recurrence. And yet there is no clear evidence in the literature that medical prophylaxis is cost effective. Various studies support the cost effectiveness of both proponents and adversaries of medical stone management. Nevertheless, there is clear evidence that medical therapy effectively prevents stone formation, especially when analyzing surrogate endpoints such as 24 urinary abnormalities, as well as primary endpoints such as stone formation. Therefore it makes intuitive sense to offer a search for underlying metabolic abnormalities in stone-forming patients and subsequently provide medical therapy, if the patient desires. Herein, we provide an overview in the medical evaluation and medical management of urinary stone disease.