Despite advances in the surgical management of urinary stone disease that have significantly reduced patient morbidity, new stone formation and recurrence remain significant health issues. Data from the United States National Health and Nutrition Examination Survey (NHANES) published in 2020 reported a kidney stone prevalence of 12% in men and 10% among women. Recent data from the US also has noted a cumulative increase in stone incidence from 0.6% to 0.9% between 2005 and 2015. An increase in stone formation among women has also been observed such that the male to female ratio appears to be decreasing. Evidence is also emerging there may be an increase in the incidence of certain stone compositions such as uric acid, a stone type linked to both dietary and metabolic risk factors. Furthermore, the association with obesity, metabolic syndrome, diabetes mellitus and stone formation suggests nephrolithiasis should be regarded as a systemic disease.

Recurrence rates after an initial symptomatic stone event are reported to be 30-50% within 10 years. Therefore, patients are generally motivated to explore prevention strategies.1 96.8% of recurrent stone formers or those with more than one concurrent stone will have a urinary metabolic abnormality. Epidemiological data from the US show that only 7% of patients with a high risk of recurrent stone disease undergo metabolic evaluation by any physician.  81% of patients interviewed would prefer to take prophylactic medication than undergo another stone episode, and 92% of respondents preferred medication to undergoing surgery. Although patients indicate they would be interested in using medication to prevent future stones, compliance studies suggest otherwise. Close to 50% of patients prescribed pharmacological prevention were non-compliant, especially those on potassium citrate. This data stresses the importance of a comprehensive metabolic assessment with implementaiton of individualized prevention strategies. With directed therapy and proper patient education, patient compliance and therapeutic success may be optimized.

with a high risk of recurrent stone disease undergo metabolic evaluation by any physician.  81% of patients interviewed would prefer to take prophylactic medication than undergo another stone episode, and 92% of respondents preferred medication to undergoing surgery. Although patients indicate they would be interested in using medication to prevent future stones, compliance studies suggest otherwise. Close to 50% of patients prescribed pharmacological prevention were non-compliant, especially those on potassium citrate. This data stresses the importance of a comprehensive metabolic assessment with implementaiton of individualized prevention strategies. With directed therapy and proper patient education, patient compliance and therapeutic success may be optimized.

This guideline is an update of the 2016 document and aims to identify patients at heightened risk of stone recurrence, to outline the required investigations to assess these patients, and to provide contemporary advice on dietary and medical interventions of proven benefit in the Canadian context. This current guideline addresses the evaluation and medical prophylaxis of upper urinary tract stones and not bladder stones.

尽管泌尿系结石病的手术治疗取得了显著降低患者发病率的进展，但新结石形成和复发仍然是重大的健康问题。2020年公布的美国国家健康和营养检查调查 (NHANES) 数据报告，男性肾结石患病率为12%，女性为10%。来自美国的最新数据也指出，2005年至2015年期间结石发病率从0.6%累积增加至0.9%。还观察到女性中结石形成增加，因此男女比例似乎在降低。也有证据表明，某些结石成分（如尿酸）的发生率可能增加，尿酸是一种与饮食和代谢风险因素相关的结石类型。此外，与肥胖、代谢综合征、糖尿病和结石形成的相关性表明，肾结石应被视为一种全身性疾病。

据报告，初次症状性结石事件后10年内的复发率为30-50%。因此，患者通常有动力探索预防策略。1 96.8%的复发性结石形成者或并发一种以上结石者会有尿代谢异常。来自美国的流行病学数据显示，只有7%的复发性结石病高风险患者接受了任何医生的代谢评价。81%的受访患者更愿意服用预防性药物而不是接受另一次结石发作，92%的受访者更喜欢药物而不是接受手术。尽管患者表示他们有兴趣使用药物预防未来的结石，但依从性研究表明相反。接近50%接受药物预防的患者不依从治疗，尤其是接受柠檬酸钾治疗的患者。这些数据强调了实施个体化预防策略进行全面代谢评估的重要性。通过定向治疗和适当的患者教育，患者的依从性和治疗成功率可以得到优化。

有高复发结石病风险的患者由任何医生进行代谢评价。81%的受访患者更愿意服用预防性药物而不是接受另一次结石发作，92%的受访者更喜欢药物而不是接受手术。尽管患者表示他们有兴趣使用药物预防未来的结石，但依从性研究表明相反。接近50%接受药物预防的患者不依从治疗，尤其是接受柠檬酸钾治疗的患者。这些数据强调了实施个体化预防策略进行全面代谢评估的重要性。通过定向治疗和适当的患者教育，可以优化患者依从性和治疗成功率。

本指南是2016年文件的更新，旨在识别结石复发风险较高的患者，概述评估这些患者所需的研究，并提供在加拿大背景下已证实获益的饮食和医疗干预的当代建议。本现行指南涉及上尿路结石而非膀胱结石的评价和药物预防。