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

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          Abstract

          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.

          Supplementary Information

          The online version contains supplementary material available at 10.1007/s00345-021-03813-3.

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          Most cited references17

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          Prevalence of kidney stones in the United States.

          Andrew D. A. C. Smith, A. J. Hanley, S Saigal … (2012)
          The last nationally representative assessment of kidney stone prevalence in the United States occurred in 1994. After a 13-yr hiatus, the National Health and Nutrition Examination Survey (NHANES) reinitiated data collection regarding kidney stone history. Describe the current prevalence of stone disease in the United States, and identify factors associated with a history of kidney stones. A cross-sectional analysis of responses to the 2007-2010 NHANES (n=12 110). Self-reported history of kidney stones. Percent prevalence was calculated and multivariable models were used to identify factors associated with a history of kidney stones. The prevalence of kidney stones was 8.8% (95% confidence interval [CI], 8.1-9.5). Among men, the prevalence of stones was 10.6% (95% CI, 9.4-11.9), compared with 7.1% (95% CI, 6.4-7.8) among women. Kidney stones were more common among obese than normal-weight individuals (11.2% [95% CI, 10.0-12.3] compared with 6.1% [95% CI, 4.8-7.4], respectively; p<0.001). Black, non-Hispanic and Hispanic individuals were less likely to report a history of stone disease than were white, non-Hispanic individuals (black, non-Hispanic: odds ratio [OR]: 0.37 [95% CI, 0.28-0.49], p<0.001; Hispanic: OR: 0.60 [95% CI, 0.49-0.73], p<0.001). Obesity and diabetes were strongly associated with a history of kidney stones in multivariable models. The cross-sectional survey design limits causal inference regarding potential risk factors for kidney stones. Kidney stones affect approximately 1 in 11 people in the United States. These data represent a marked increase in stone disease compared with the NHANES III cohort, particularly in black, non-Hispanic and Hispanic individuals. Diet and lifestyle factors likely play an important role in the changing epidemiology of kidney stones. Published by Elsevier B.V.
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            Kidney Stone Disease: An Update on Current Concepts

            Tilahun Alelign, Beyene Petros (2018)
            Kidney stone disease is a crystal concretion formed usually within the kidneys. It is an increasing urological disorder of human health, affecting about 12% of the world population. It has been associated with an increased risk of end-stage renal failure. The etiology of kidney stone is multifactorial. The most common type of kidney stone is calcium oxalate formed at Randall's plaque on the renal papillary surfaces. The mechanism of stone formation is a complex process which results from several physicochemical events including supersaturation, nucleation, growth, aggregation, and retention of urinary stone constituents within tubular cells. These steps are modulated by an imbalance between factors that promote or inhibit urinary crystallization. It is also noted that cellular injury promotes retention of particles on renal papillary surfaces. The exposure of renal epithelial cells to oxalate causes a signaling cascade which leads to apoptosis by p38 mitogen-activated protein kinase pathways. Currently, there is no satisfactory drug to cure and/or prevent kidney stone recurrences. Thus, further understanding of the pathophysiology of kidney stone formation is a research area to manage urolithiasis using new drugs. Therefore, this review has intended to provide a compiled up-to-date information on kidney stone etiology, pathogenesis, and prevention approaches.
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              Study on the prevalence and incidence of urolithiasis in Germany comparing the years 1979 vs. 2000.

              A. Hesse, E. Brändle, D Wilbert … (2003)
              In 1979, we conducted a representative study to determine the prevalence and incidence of urolithiasis in Germany. Significant progress in stone therapy and changes in nutritional and environmental factors since then consequently led to a second study in 2001 under the same conditions as in 1979. A representative sample of 7500 persons from all over Germany was questioned on the occurrence of urinary stones during their lifetimes (prevalence) and on acute urolithiasis in 2000 (incidence). Additionally, data were collected on urinary stone therapy and metaphylaxis. The current data were then compared with those from 1979. Prevalence has risen from 4% to 4.7% from 1979 to 2001. 9.7% of the 50-64 year old males in 2000 had already had urinary stones (females: 5.9%). The current recurrence rate of urinary stones was estimated to be 42%. In the year 2000, the incidence of urolithiasis in Germany was found to be 1.47% (1979: 0.54%). Over 40% of the stones were passed spontaneously. There has been a marked increase in the prevalence and incidence of urolithiasis in Germany within the last 22 years. This probably results from improvements in clinical-diagnostic procedures, changes in nutritional and environmental factors and a general apathy towards metabolic clarification and metaphylaxis.
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                Author and article information

                Contributors
                Alina Reicherz:
                ORCID: http://orcid.org/0000-0003-1587-4432
                alina.reicherz@rub.de
                Journal
                Journal ID (nlm-ta): World J Urol
                Journal ID (iso-abbrev): World J Urol
                Title: World Journal of Urology
                Publisher: Springer Berlin Heidelberg (Berlin/Heidelberg )
                ISSN (Print): 0724-4983
                ISSN (Electronic): 1433-8726
                Publication date (Electronic): 18 August 2021
                Publication date PMC-release: 18 August 2021
                Publication date (Print): 2022
                Volume: 40
                Issue: 1
                Pages: 237-242
                Affiliations
                [1 ]GRID grid.5570.7, ISNI 0000 0004 0490 981X, Department of Urology, Marien Hospital Herne, , Ruhr-University of Bochum, ; Hölkeskampring 40, 44625 Herne, Germany
                [2 ]Department of Urology, University Carl Gustav Carus, Dresden, Germany
                Author information
                http://orcid.org/0000-0003-1587-4432
                Article
                Publisher ID: 3813
                DOI: 10.1007/s00345-021-03813-3
                PMC ID: 8813807
                PubMed ID: 34406436
                SO-VID: eb3da8dc-7767-4d1c-908b-8decd64899c3
                Copyright © © The Author(s) 2021
                License:

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                Date received : 22 April 2021
                Date accepted : 11 August 2021
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100001659, Deutsche Forschungsgemeinschaft;
                Award ID: RE 4611/2-1
                Award Recipient :
                Funded by: Universitätsklinikum der Ruhr-Universität Bochum (1007)
                Open Access :

                Open Access funding enabled and organized by Projekt DEAL.

                Categories
                Subject: Original Article
                Custom metadata
                issue-copyright-statement © Springer-Verlag GmbH Germany, part of Springer Nature 2022

                ScienceOpen disciplines: Urology
                Keywords: prevention,recurrent urinary stone disease,survey,empirical study,germany
                Data availability:
                ScienceOpen disciplines: Urology
                Keywords: prevention, recurrent urinary stone disease, survey, empirical study, germany

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