BACKGROUND AND OBJECTIVE: The aim of this review was to define patients who are at high risk of recurrence of urolithiasis, to delineate diagnostic and therapeutic algorithms for each type of stone, and to clarify general guidelines and recommendations for prevention of recurrence. METHODS: A professional research librarian carried out literature searches for all sections of the urolithiasis guidelines, covering the timeframe between 1976 and June 2023. KEY FINDINGS AND LIMITATIONS: For every patient with urolithiasis, an attempt should be made to analyse the stone. Patients should be given general instructions on how to prevent recurrence, including adequate fluid and calcium intake, and low consumption of sodium and protein. Identifying and correcting the causative factors is a cornerstone in preventing the recurrence of urolithiasis. Diagnostic and therapeutic algorithms by stone composition are available. Every patient should undergo baseline metabolic screening, while patients with calcium stones, who are at high risk of relapse and complications, should undergo extensive metabolic screening with two 24-h urine collections and should receive targeted therapy. Patients with uric acid, infection, or cystine stones are at high risk of relapse. All patients at high risk of recurrence should be closely monitored, especially those not complying with therapy in the long term. CONCLUSIONS AND CLINICAL IMPLICATIONS: Metabolic stone evaluation and patient follow-up are highly recommended to prevent urolithiasis recurrence.

Department of Urology Connolly Hospital Dublin Ireland

Department of Urology Freeman Hospital Newcastle upon Tyne UK

Department of Urology Hospital of the Brothers of Mercy Trier Medical Campus University Mainz Trier Germany

Department of Urology Region Hospital Ceske Budejovice Czechia

Department of Urology University Hospital Southampton NHS Foundation Trust Southampton UK

Division of Nephrology and Dialysis Department of Medicine University of Verona Verona Italy

European Association of Urology Guidelines Office Arnhem The Netherlands

National and Kapodistrian University of Athens 2nd Department of Urology Sismanogleio Hospital Athens Greece

Sant 'Andrea Hospital Sapienza University Rome Italy

Servicio de Urología Hospital Universitario de Gante Gante Belgium

Urinvejskirurgisk Afdeling Sygehus Lillebælt Vejle Denmark

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