Background:

Urolithiasis is a prevalent urological condition with high recurrence rates. Increasing evidence links metabolic syndrome (MetS) and its components to urinary stone disease, but the relationship between MetS and stone recurrence, including the roles of stone composition, residual fragments, urinary biochemistry, and lifestyle factors, remains underexplored.

Objectives:

To investigate the association between MetS components and urinary stone recurrence in a retrospective cohort, with emphasis on stone composition, surgical residual fragments, urinary biochemical parameters, and lifestyle factors.

Design:

A single-center retrospective case–control study.

Methods:

We enrolled 542 patients with urinary stones (2019–2020) and followed them for up to 5 years (median follow-up 48 months). Baseline demographic, metabolic, lifestyle, urinary biochemical, surgical, and stone composition data were collected. Kaplan–Meier and Cox regression analyses were used to evaluate recurrence-free survival and independent predictors of recurrence.

Results:

During follow-up, 211 patients (39%) experienced recurrence. The prevalence of MetS was significantly higher in the recurrence group (46.9% vs 28.7%). Cox regression identified hypertension (hazard ratio (HR) 1.31, 95% CI 1.04–1.65), hyperglycemia (HR 1.29, 1.01–1.64), hypertriglyceridemia (HR 1.38, 1.08–1.77), and residual fragments (HR 1.89, 1.47–2.43) as independent predictors. Stone composition analysis revealed higher recurrence in uric acid (52.3%), struvite (59.3%), and cystine (63.6%) stones compared with calcium oxalate (34.0%). Adverse urinary profiles (low pH, hypocitraturia, hyperuricosuria) and lifestyle factors (low fluid intake, high salt, high animal protein) were also associated with recurrence. Kaplan–Meier analysis showed shorter recurrence-free survival in patients with MetS (log-rank p < 0.001).

Conclusion:

MetS and its components are independently associated with a higher risk of urinary stone recurrence. Stone composition, residual fragments, urinary biochemistry, and lifestyle factors further modify recurrence risk. These findings underscore the importance of comprehensive risk stratification and metabolic management in patients with urolithiasis.

Trail registration:

Not applicable.

Plain language summary

Metabolic syndrome and urinary stone recurrence

Background: Urolithiasis is a prevalent urological condition with high recurrence rates. Increasing evidence links metabolic syndrome (MetS) and its components to urinary stone disease, but the relationship between MetS and stone recurrence, including the roles of stone composition, residual fragments, urinary biochemistry, and lifestyle factors, remains underexplored.

Objectives: To investigate the association between MetS components and urinary stone recurrence in a retrospective cohort, with emphasis on stone composition, surgical residual fragments, urinary biochemical parameters, and lifestyle factors. Design: A single-center retrospective case-control study.

Methods: We enrolled 542 patients with urinary stones (2019–2020) and followed them for up to 5 years (median follow-up 48 months). Baseline demographic, metabolic, lifestyle, urinary biochemical, surgical, and stone composition data were collected. Kaplan–Meier and Cox regression analyses were used to evaluate recurrence-free survival and independent predictors of recurrence.

Results: During follow-up, 211 patients (39%) experienced recurrence. The prevalence of MetS was significantly higher in the recurrence group (46.9% vs 28.7%). Cox regression identified hypertension (HR 1.31, 95% CI 1.04–1.65), hyperglycemia (HR 1.29, 1.01–1.64), hypertriglyceridemia (HR 1.38, 1.08–1.77), and residual fragments (HR 1.89, 1.47–2.43) as independent predictors. Stone composition analysis revealed higher recurrence in uric acid (52.3%), struvite (59.3%), and cystine (63.6%) stones compared with calcium oxalate (34.0%). Adverse urinary profiles (low pH, hypocitraturia, hyperuricosuria) and lifestyle factors (low fluid intake, high salt, high animal protein) were also associated with recurrence. Kaplan–Meier analysis showed shorter recurrence-free survival in patients with MetS (log-rank P < 0.001).

Conclusion: MetS and its components are independently associated with higher risk of urinary stone recurrence.