How do you approach prevention of kidney stones in patients with an ileal diversion and recurrent nephrolithiasis?

My first step, is to perform a kidney stone analysis. Kidney stones are not a "monolithic" disorder; rather they are "symptoms" of a diverse group of renal mineral metabolism and acid-base disorders. my next step in this case would be to obtain a 24-hour urine supersaturation study. I would be particularly concerned about urine volume, pH, and oxalate excretion. Depending on the data generated, I would then prescribe goal-directed therapy. Follow-up is particularly important. A repeat 24-hour urine on the new treatment program will tell us whether we have ameliorated the major risk factors. Repeat imaging, preferably CT scanning, is also important to look for "metabolic inactivity," meaning the lack of new stone formation and lack of growth...

I completely agree with Drs. @Dr. First Last and @Dr. First Last. My only caveat is that I like to get 2 sequential 24-hour urines for the first collection and then follow up with a 24-hour one about 3-4 months after initiating therapy. I would also get a renal US at 6 months as opposed to CT as I like to avoid radiation.