Metabolic evaluation in paediatric urolithiasis: Is a key component being overlooked? An international survey by the YAU-PU Working Group

Paediatric urolithiasis is increasing globally, with metabolic abnormalities as a key contributing factor. However, standardized protocols for metabolic evaluation in children are lacking. This study assessed current practices and knowledge among paediatric urologists worldwide. An international survey was distributed in Spanish and English, gathering data on clinician demographics and metabolic evaluation strategies. A total of 194 clinicians from 49 countries responded. Only 11% routinely performed metabolic evaluations, and while 78% requested stone analysis, just 46% ordered 24-hour urine studies. In 84% of cases, paediatric nephrologists were responsible for evaluations, with urologists involved in fewer than 25%. Knowledge of spot urine indices varied, and only 55% recognized crystalluria as a lithogenic risk factor. Fewer than one-third felt confident interpreting metabolic results or initiating treatment. These findings highlight inconsistent practices and limited involvement of paediatric urologists, underscoring the need for clearer guidelines and targeted education to enhance metabolic assessment in stone disease.