An empirical study on hospital-based prevention of recurrent urinary stone disease in Germany

Purpose!#!Urinary stone disease is a common disease with a prevalence of 4.7% in Germany. The incidence increased over the last decades, and recurrence rates are up to 50% in the first 5 years after diagnosis. Adequate preventive measures can avoid up to 46% of stone recurrences. These numbers outline the importance of prevention. Especially among high-risk stone formers, specific diagnostics and measures are required. Published data indicate the divergence between the importance of prevention and its implementation in everyday clinical practice. This is the first survey among German urological departments highlighting medical care concerning the prevention of recurrent urinary stone disease, identifying challenges and providing recommendations for improvements.!##!Methods!#!Two hundred and seventy urological hospital departments in Germany were anonymously surveyed about measurements to prevent recurrent stone disease. The questionnaire comprised 23 items dealing with diagnostics, counselling, knowledge among doctors concerning preventive measures and difficulties in preventing recurrent urinary stone disease.!##!Results!#!Sixty-three urological departments (23.8%) answered the survey. The majority perform stone analysis at first and repeat events. Most patients with urinary stone disease receive general advice on preventive measures during their hospitalization. General recommendations focus on fluid intake and lifestyle changes. However, specific diets are infrequently recommended by inpatient urologists. Diagnostics to identify high-risk stone formers are mostly insufficient, and guideline-compliant urine tests are uncommon.!##!Conclusion!#!The quality of secondary prevention needs to improve considerably. The focus should be put on identifying high-risk stone formers and offering those patients specific counselling. Furthermore, general advice on dietary recommendations should be extended

Prophylaxis of recurrent stone disease in outpatient clinics in Germany

$\bf Introduction:$ The aim of the study was to survey current practices for preventing recurrent stone disease in an outpatient clinic setting in Germany. $\bf Methods:$ Two invitations to complete an anonymous REDCap® survey were emailed to members of the occupational union of German urologists who work as outpatient urologists (“Berufsverband Deutscher Urologen e.V.”). The survey included questions on diagnostic modalities and counselling to prevent stone disease. $\bf Results:$ A total of 130 outpatient urologists completed the survey. 84.6% of urologists give general advice to first-time stone formers. Recommendations comprise increased fluid uptake in 100%, two-thirds advice on calcium and oxalate intake, and one-third on salt and protein intake. 64.6% perform a metabolic evaluation for high-risk stone formers. However, patients with risk factors other than repeat stone disease are often overlooked. Urologists agreed that a lack of time (73.1%) and reimbursement (64.6%), as well as insufficient patient compliance (60.8%), pose significant challenges. The majority of urologists agreed that training is required. $\bf Conclusion:$ General recommendations for stone formers are usually provided, but nutritional advice tends to be incomplete. Our results raise quality-of-care concerns: Metabolic evaluation of stone formers at high risk of recurrence is uncommon. Structural changes are required due to time constraints, and poor remuneration must be addressed to improve patient care

An empirical study on hospital-based prevention of recurrent urinary stone disease in Germany

$\bf Purpose$ Urinary stone disease is a common disease with a prevalence of 4.7% in Germany. The incidence increased over the last decades, and recurrence rates are up to 50% in the first 5 years after diagnosis. Adequate preventive measures can avoid up to 46% of stone recurrences. These numbers outline the importance of prevention. Especially among high-risk stone formers, specific diagnostics and measures are required. Published data indicate the divergence between the importance of prevention and its implementation in everyday clinical practice. This is the first survey among German urological departments highlighting medical care concerning the prevention of recurrent urinary stone disease, identifying challenges and providing recommendations for improvements. $\bf Methods$ Two hundred and seventy urological hospital departments in Germany were anonymously surveyed about measurements to prevent recurrent stone disease. The questionnaire comprised 23 items dealing with diagnostics, counselling, knowledge among doctors concerning preventive measures and difficulties in preventing recurrent urinary stone disease. $\bf Results$ Sixty-three urological departments (23.8%) answered the survey. The majority perform stone analysis at first and repeat events. Most patients with urinary stone disease receive general advice on preventive measures during their hospitalization. General recommendations focus on fluid intake and lifestyle changes. However, specific diets are infrequently recommended by inpatient urologists. Diagnostics to identify high-risk stone formers are mostly insufficient, and guideline-compliant urine tests are uncommon. $\bf Conclusion$ The quality of secondary prevention needs to improve considerably. The focus should be put on identifying high-risk stone formers and offering those patients specific counselling. Furthermore, general advice on dietary recommendations should be extended