Monitoring
Stone analysis should be done after passage of stone with evaluation of risk factors to determine possibility of recurrence. A 24-hour urine specimen should be obtained 8-12 weeks after initiation of pharmacological intervention for prevention of recurrence. Assess the response to dietary and/or medical therapy. After the initial follow-up, a 24-hour urine specimen should be obtained annually or with greater frequency, depending on the stone activity. Assess patient’s adherence and metabolic response. Obtain periodic blood testing. Advise the patient to increase intake of fruits and vegetables. Assess for adverse effects in patients on pharmacological therapy. Repeat stone analysis, when available, especially in patients not responding to treatment. Monitor patients with struvite stones for re-infection with urease-producing organisms and utilize strategies to prevent such occurrences. Obtain follow-up imaging studies to assess stone growth or new formation based on stone activity (eg plain abdominal imaging, renal US, or low-dose CT scan). Imaging is recommended 4 weeks after initial treatment with SWL, ureteroscopy, or PNL to detect residual fragments. NCCT has greater sensitivity for detecting small residual fragments after definitive treatment of ureteral or renal stones. Residual fragments >4 mm should be treated.