Lancet
Intensive hydration-adherence program fails to reduce recurrent urinary stones
The 1,658‑participant PUSH trial across six U.S. centers evaluated whether a multicomponent behavioral program—fluid prescriptions, financial incentives, health coaching, and patient‑selected reminder tools—could reduce symptomatic urinary‑stone recurrence in patients aged ≥12 with low 24‑hour urine volumes. Despite successfully increasing urine output at multiple timepoints (6, 12, 18, and 24 months), the intervention did not outperform guideline‑based care in preventing recurrent symptomatic stone events over two years: recurrence occurred in 19% of intervention vs. 20% of control participants (hazard ratio, 0.96; 95% confidence interval, 0.77–1.20). The cohort was predominantly recurrent stone formers (67%), and urinary storage symptoms were higher in the intervention group at 6 and 12 months. No cases of hospitalization‑requiring hyponatremia occurred, though asymptomatic hyponatremia was slightly more common with the intervention (1% vs. <1%).
Clinical takeaway: Reinforce hydration counseling but recognize that even structured adherence programs may not reduce recurrence. Consider tailored, multimodal prevention strategies—dietary, metabolic, or pharmacologic—beyond hydration alone.
Source:
Desai A, et al. (2026, March 21). Lancet. Prevention of urinary stones with hydration: a randomised clinical trial of an adherence intervention. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(25)02637-6/abstract
