Risk Factors Associated with Recurrence of Urolithiasis Following Endourological Management: A Prospective Observational Cohort Study.

Original Article

Abstract

Background: Despite successful endourological treatment, urolithiasis frequently relapses, leading to multiple interventions, high health care expenses, and reduced quality of life. To better plan preventive measures to minimize recurrence and maximize long-term patient outcomes, it is important to identify the factors associated with recurrence.

Objective: To determine the recurrence rate of urolithiasis and identify demographic, clinical, metabolic, surgical, and lifestyle factors associated with recurrence following endourological management.

Methods: This prospective observational cohort study was conducted in the Department of General Surgery at Lady Reading Hospital, Peshawar, Pakistan, from July 2025 to December 2025. We enrolled adults undergoing URS, RIRS, or PCNL consecutively and followed them for 12 months. We recorded demographic, clinical, metabolic, surgical, and lifestyle factors. We assessed recurrent urolithiasis using follow-up imaging. Data were analyzed using SPSS version 27.0, and multivariable logistic regression was performed to identify factors independently associated with recurrence.

Results: The study included 68 males and 32 females, with a mean age of 44.2 ± 11.6 years. During one-year follow-up, 34 (34.0%) patients developed recurrent urolithiasis. Significant risk factors included obesity (52.9% vs. 21.2%, p=0.006), diabetes mellitus (44.1% vs. 22.7%, p=0.028), family history of stone disease (50.0% vs. 19.7%, p=0.003), daily fluid intake <2 L (61.8% vs. 28.8%, p=0.001), residual stone fragments (41.2% vs. 12.1%, p=0.002), and recurrent urinary tract infection (38.2% vs. 16.7%, p=0.018). The type of endourological procedure was not significantly associated with recurrence (p=0.471). Independent predictors included inadequate fluid intake (AOR=3.12), residual fragments (AOR=2.81), obesity (AOR=2.35), and positive family history (all p<0.05).

Conclusion: After endourological management, one third of patients had recurrent urolithiasis. Non-hydration, obesity, stone fragments, and family history were independent risk factors for stone recurrence. To reduce recurrence risk and optimize long-term outcomes, comprehensive metabolic assessment, stone clearance, lifestyle modification, and regular postoperative follow-up are recommended.