Stone recurrence falls by half with fluids, and further when a metabolic cause is found and treated

The edition in brief

A narrative review of randomised trials, cohorts and guidelines on stone prevention found higher fluid intake roughly halves recurrence (RR about 0.45–0.55), a normal-calcium, low-salt, lower animal protein diet does similarly in hypercalciuric calcium oxalate formers, and targeted drugs reduce it further — potassium citrate (RR about 0.25), allopurinol (0.59) and thiazides (0.52), though the NOSTONE trial found no thiazide benefit. Evidence that 24-hour-urine-directed therapy beats empirical advice is confined to high-risk and recurrent formers. In post hoc analyses of LATITUDE and ARASENS, testosterone above 35 ng/dL during intensified therapy for metastatic hormone-sensitive prostate cancer was associated with worse survival in LATITUDE (HR 1.49) but not significantly in ARASENS. In 100 nerve-sparing robotic prostatectomies scored on video, cases ending in erectile dysfunction at a year had 43% more errors and 67% more neurovascular bundle errors. In the LURN cohorts, urinary urgency was associated with three-fold odds of vascular disease, and erectile dysfunction affected 64% of men with urgency incontinence. The pearl covers the obstructed, infected kidney.