What is your approach to patients with recurrent nephrolithiasis and low urine volumes who struggle with increasing fluid intake following a sleeve gastrectomy procedure?

This is a difficult situation for both the patient and the provider. I think the best solution is for them to drink small quantities of fluid frequently. This creates a compliance problem. I encourage patients to have fluid regularly available, meaning that they may have to take it with them to work or other activities. Remembering to drink it, even when not thirsty, is the second basic problem. I encourage patients to link drinking to activities they do frequently, such as checking their cell phone or changing classes, or using the bathroom, etc.

Stephen B. Erickson, MD

Hydration rate cannot be very large, so I teach small numerous intake. A favorite of mine is 1/2 liter water bottles, the goal set by how many are filled and put in the fridge the night before. Sipping, and small drinks work if there is a goal of so many of these used in a day. How many depends on the patient.