What is your approach to the management of patients with recurrent nephrolithiasis who continue to have elevated stone risk parameters in the setting of dietary factors despite receiving education from a dedicated stone clinic dietician?

Diets are notoriously difficult to follow. Once it is apparent that the patient is not going to get satisfactory control of metabolic stone disease (an increase in stone number or size as opposed to the passage of pre-existing stones, unchanged in size or number), it is time to start preventative me...

One or more 24-hour urine studies to get a better understanding of urinary risk factors, and then look to add/titrate medications.