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A National Survey of Provider Practice Patterns for Evaluation and Management of Patients With Urinary Stone Disease

Year: 2026

Type: article

Abstract: Rationale and Objective Urinary stone disease (USD) is increasing in prevalence and contributes to significant morbidity and healthcare costs. Utilization of secondary prevention measures remains low. We aimed to characterize provider practice patterns, barriers, and attitudes toward metabolic evaluation, treatment, and radiologic surveillance of USD. Study Design National cross-sectional survey between 2024 and 2025 Setting and Participants Physicians, nurse practitioners, and physician assistants who care for patients with USD. Exposure American Urological Association guidelines for medical management of USD Outcomes Implementation of 24-hour urine testing, dietary and pharmacologic interventions, imaging practices, and perceived barriers to secondary prevention Analytical Approach Responses were summarized descriptively and stratified by specialty Results Ninety-three respondents completed the survey (88% physicians; 46% urology, 34% nephrology); the remaining were advanced practice providers. Overall, 60% reported ordering 24-hour urine testing in all or more than half of their patients, though frequency differed by specialty (72% of nephrologists compared with 63% of urologists). Most (93%) agreed that 24-hour urine testing is necessary and felt confident in interpreting results. The leading barrier was the perceived burden for patients to complete urine collections (35%). Among respondents who obtained 24-hour urine testing, 77% interpreted results for dietary counseling and 91% for medication selection. Imaging strategies also varied: 32% of nephrologists compared with 11% of urologists rely on CT alone to survey stone burden. Most providers who did not practice surveillance imaging cited concerns about radiation exposure (25%) and pursued imaging only when their patients developed symptoms (80%). Limitations Survey design was cross-sectional; most respondents were affiliated with an academic institution. Conclusions Most providers caring for patients with USD use 24-hour urine testing to inform treatment strategies but they may not consistently order 24-hour urine tests due to the perception that urine collections are burdensome for patients. Twenty-four-hour urine testing, prescription of stone medications, and surveillance imaging vary by specialty.

Source: Kidney Medicine

DOI: 10.1016/j.xkme.2026.101520