Urinary Metabolic Evolution After Stone Clearance: A Narrative Review of Temporal Changes, Determinants, and Clinical Implications Following Surgical Management of Nephrolithiasis
| Author | Mohammad Hassan Haghighi Zadeh | en |
| Issued Date | 2026-10-31 | en |
| Abstract | Context: Nephrolithiasis is a chronic metabolic disorder for which surgical intervention can achieve stone clearance but may not correct underlying urinary abnormalities. This narrative review aimed to evaluate changes in 24-hour urinary metabolic parameters before and after the surgical management of nephrolithiasis and to discuss their clinical implications for recurrence prevention. Evidence Acquisition: A structured literature search was conducted in PubMed, Scopus, and Google Scholar through March 2026. Studies were included if they enrolled adult patients undergoing percutaneous nephrolithotomy, ureteroscopy/retrograde intrarenal surgery, or shock wave lithotripsy and reported pre- and postoperative 24-hour urinary metabolic parameters. Changes in urinary calcium, oxalate, citrate, uric acid, urine volume, pH, and supersaturation were qualitatively synthesized, considering study design, surgical modality, stone characteristics, and the timing of urine collection. Results: Urinary metabolic abnormalities frequently persist after surgical stone removal. Although some studies report improvements in urinary citrate, urine volume, or supersaturation, persistent abnormalities, including hypercalciuria, hyperoxaluria, and altered urinary pH, remain common. Differences among studies may be related to stone composition, baseline metabolic status, dietary factors, hydration, infection resolution, and postoperative assessment timing. Procedure-related changes in urinary biomarkers after shock wave lithotripsy or ureteroscopy appear to be transient and should be distinguished from long-term lithogenic risk. Supersaturation provides a more integrated assessment of stone-forming potential than do individual urinary parameters. Conclusions: Surgical treatment of nephrolithiasis should be considered primarily a stone-clearing procedure rather than a definitive metabolic correction. Postoperative 24-hour urine evaluation remains important for identifying persistent risk factors and guiding individualized prevention strategies. Further prospective studies with standardized follow-up protocols are warranted. | en |
| DOI | https://doi.org/10.5812/mejrh-173206 | en |
| URI | https://brieflands.com/journals/mejrh/articles/173206 | en |
| Keyword | Nephrolithiasis | en |
| Keyword | 24-hour Urine Analysis | en |
| Keyword | Metabolic Evaluation | en |
| Keyword | Urinary Supersaturation | en |
| Keyword | Kidney Stone Surgery | en |
| Keyword | Recurrence Prevention | en |
| Publisher | Brieflands | en |
| Title | Urinary Metabolic Evolution After Stone Clearance: A Narrative Review of Temporal Changes, Determinants, and Clinical Implications Following Surgical Management of Nephrolithiasis | en |
| Type | Review Article | en |
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