The Diagnostic Evaluation of Risk Factors for Urinary Tract Stones: An Analysis of Care Patterns in Five Hospitals

Medical records of hospitalized primary urolithiasis patients in five Connecticut hospitals were studied to determine the aggressiveness of the diagnostic search for metabolic and other renal stone risk factors. A total of 924 patients over three years were analyzed. Routine serum, urine, and X-ray tests were generally performed according to accepted criteria. However, medical histories were generally inadequate, and 24-hour urine studies for calcium and uric acid were performed on less than half of the patients for whom they were indicated. Neither the complexity of the stone problem nor the stone event number appeared to influence the intensity of the diagnostic search in any important way. Other deficiencies included the lack of followup of abnormal test findings and the lack of treatment of problems discovered. The diagnostic approach in each hospital was stable over time.