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Reza S. Malek, MD, FRCS, FACS, FAAP
Arch Intern Med. 1982;142(6):1089. doi:10.1001/archinte.1982.00340190045007.
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Urolithiasis is, indeed, a costly and crippling health problem; the estimated annual patient cost in the United States is at least $47.3 million.

In fact, urolithiasis is only a complication of a large number of variable, complex, and at times mystical underlying disorders. Per se, it may, indeed, be regarded as a locally malignant condition that primarily affects persons aged 20 to 40 years. The high rate of recurrence, which ranges from 9% to 73% at an interval of approximately nine years, and multitude of operations to which a large number of poorly evaluated, incorrectly diagnosed, and inadequately treated stone formers are usually subjected serve to illustrate this point. Tragically, about one third of patients having one or more episodes of upper tract calculi eventually will lose a kidney.

A number of screening studies including determination of serum and urine biochemical profile, bacteriologic examination of urine, analysis of any available


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