Introduction & Objectives
\nUrolithiasis is associated with recurrence rates approaching 50% within 5 years, making secondary prevention a central component of care. International guidelines emphasise routine stone analysis and metabolic evaluation to identify modifiable risk factors and guide targeted therapy. This study aimed to assess compliance with established recommendations for post-ureteroscopy (URS)evaluation and to identify gaps in preventive practice.
\nMaterials & Methods
\nA retrospective clinical audit was conducted including 221 consecutive patients undergoing URS for stone disease over an 18-month period (January 2024\u2013June 2025). Data were extracted from electronic patient records and a prospectively maintained stone database. Key metrics included stone retrieval, rate of stone analysis, metabolic blood screening, and 24-hour urine testing in recurrent or high-risk patients. Compliance was assessed against European Association of Urology (EAU) and American Urological Association (AUA) guidelines.
\nResults
\nStone retrieval was successful in 77.4% (171\/221) of procedures. Among retrieved stones, 71.3% were sent for analysis, leaving 28.7% unanalysed despite availability. Metabolic blood screening demonstrated high compliance at 91.9%. However, among recurrent or high-risk patients, only 50% underwent 24-hour urine metabolic evaluation. Mixed and calcium-based stones were the most frequently identified compositions. Identified barriers included lack of standardised workflows, intra operative time pressures,perceived redundancy of repeat analysis, and both patient- and clinician-related challenges affecting 24-hour urine collection.
\nConclusions
\nDespite acceptable surgical outcomes and good adherence to basic metabolic screening, significant deficiencies persist in stone analysis and comprehensive metabolic evaluation. These shortcomings limit the implementation of effective, evidence-based secondary prevention strategies and may contribute to avoidable recurrence. Standardisation of post-URS pathways, improved clinician awareness, and structured referral to metabolic stone services are essential to optimise patient outcomes. Re-audit following targeted interventions is warranted to ensure alignment with guideline standards.<\/p>","protected":false},"excerpt":{"rendered":"
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