American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the primary treatment for struvite nephrolithiasis?

1. Medication therapy

2. Diet modification

3. Removing the stone

4. Observation only

The correct answer is: Removing the stone

Struvite nephrolithiasis, often associated with urinary tract infections caused by urease-producing bacteria, results in the formation of large, staghorn calculi. These stones can lead to significant morbidity, including recurrent urinary tract infections, obstruction, and potential kidney damage. The primary treatment approach for struvite stones is removal of the stones themselves. This is necessary not only to alleviate symptoms and complications but also to prevent further stone formation, as struvite stones can re-form quickly after the infection is resolved. Surgical interventions, such as percutaneous nephrolithotomy or ureteroscopy, are commonly employed to effectively remove these large stones. While medication and dietary modifications can sometimes play a role in the management of other types of nephrolithiasis, they are not sufficient for struvite stones, particularly when the stones are symptomatic or obstructive. Observation may be an approach in certain asymptomatic cases, but it is not a standard treatment for struvite nephrolithiasis given the serious implications of untreated stones in this context. By focusing on the removal of struvite stones, this approach addresses both the immediate health concerns and the underlying processes of struvite stone formation, leading to more effective long-term management of the