Dietary and lifestyle modifications are widely prescribed to prevent recurrence of urolithiasis, although little is known about the clinical and demographic factors associated with patient compliance and urinary metabolic changes. The present study assessed the clinical and demographic factors influencing compliance with a modified diet and lifestyle in first-time ureteric stone formers as well as determined the effects of compliance on urinary stone risk factors. We retrospectively reviewed the medical records of 53 patients presenting with ureteric calcium stones. Using a self-completed questionnaire, patients were classified according to compliance with seven recommendations for modifying diet and lifestyle into good compliance group (complied with ≥ three recommendations) and poor compliance group. Before (on a random diet) and after prescribing the modifications, 24 hour urine samples were collected from those in the good and poor compliance group. The stone size at presentation and initial treatment modality were closely associated with patient compliance (P=0.019, P=0.027, respectively). Citrate excretion significantly increased in the good compliance group after adopting modifications (P=0.012), whereas the poor compliance group did not show a statistically significant difference. Moreover, patients in the poor compliance group showed significantly increased urinary calcium excretion by the end of the study (P=0.040). After adjustments for age, sex, body mass index, and metabolic abnormality status, poor compliance was found to be an independent risk factor for persistence or development of hypocitraturia (OR: 3.885; 95% CI: 1.102~13.694; P=0.035). In conclusion, our results imply that patient education programs regarding diet and lifestyle should be tailored to the individual’s clinical and demographic characteristics.

Introduction
 Materials and Methods
  Patient characteristics and data collection
  Measurement and definition of parameters
  Statistical analysis
 Results
  Baseline characteristics
  Patient compliance with diet and lifestyle modification
  Demographic and clinical factors are associated with patient compliance
  Subsequent metabolic changes according to patient compliance
 Discussion
 Conclusions
 Acknowledgements
 ORCID
 References

• Sung Pil Seo(Department of Urology, College of Medicine, Chungbuk National University)
• Ho Won Kang(Department of Urology, College of Medicine, Chungbuk National University)
• Won Tae Kim(Department of Urology, College of Medicine, Chungbuk National University)
• Yong-June Kim(Department of Urology, College of Medicine, Chungbuk National University)
• Seok-Joong Yun(Department of Urology, College of Medicine, Chungbuk National University)
• Wun-Jae Kim(Department of Urology, College of Medicine, Chungbuk National University)
• Sang-Cheol Lee(Department of Urology, College of Medicine, Chungbuk National University) Corresponding author