Comparing Empiric and Selective Medical Treatments to Prevent Calcium Oxalate Kidney Stones After Surgery

What this Trial Is About

Researchers are evaluating two medical treatment approaches to prevent calcium oxalate kidney stones in patients undergoing percutaneous nephrolithotomy PCNL at a single center. This randomized controlled trial aims to compare empiric therapy, based on stone composition and urinalysis, to selective therapy guided by 24-hour urine metabolic evaluation. The primary goal is to see if a simpler empiric method can achieve similar outcomes as the more detailed selective therapy by measuring changes in calcium oxalate supersaturation four weeks after treatment. Participants will be randomly assigned after surgery to either the empiric or selective therapy groups. The empiric group receives treatment based on stone type low oxalate diet counseling for calcium oxalate monohydrate stone formers, chlorthalidone 25 mg daily for calcium oxalate dihydrate stone formers, or both if stones contain equal parts of each type. The selective group receives therapy guided by 24-hour urine results, following American Urological Association guidelines, with diet or chlorthalidone prescribed based on specific urine findings such as hyperoxaluria or hypercalciuria. During the study, participants will be monitored for changes in calcium oxalate supersaturation at 4 to 6 weeks post-treatment. Additional assessments include urinary oxalate and calcium levels and adherence to chlorthalidone therapy using a questionnaire. The study involves medical evaluations, dietary counseling, and medication monitoring to understand which approach best prevents recurrent stones, with a total participation timeframe covering treatment and follow-up over several weeks.

CaOx Stone Prevention