CoMET: New patient survey examining calcium-oxalate stone patient compliance

A new study was recently published by the EAU Section of Urolithiasis’s (EULIS) eCORE Working Group, with the help of the EAU Research Foundation (EAU RF). The study, ‘Patient compliance for metabolic evaluation and medical treatment (CoMET) in calcium-oxalate stone patients’ examines which factors are crucial in determining patient compliance. It involved 346 patients from 9 different centres over a two-and a-half year period.

Wed, 3 Jan 2024
UrolithiasisEAU Foundation For Urological Research

CoMET examines calcium-oxalate stone patient compliance

We spoke to one of its authors, Prof. Selçuk Güven (Konya, TR) about the main findings of the study and the role of the EAU’s Research Foundation in supporting its success.

Patient compliance

In general, the study found a 71.7% compliance rate to the metabolic evaluation and 65.3% compliance to diet. Of the 215 patients who were offered medical treatment, 63.7% were then compliant. Univariate analysis determined several factors that had effect on compliance rates.

Compliance to metabolic analysis was impacted by the level of education that the patients had received (e.g.: elementary or high school, university etc.), having a positive history of emergency department visit, and having previously undergone a greater number of stone surgeries. Compliance to dietary advice was similarly affected by higher levels of education and a positive history of emergency department visit, but also the presence of comorbidities and polypharmacy. Another identified factor is the setting of the treatment, for example in dedicated stone clinics.

Prof. Güven, on behalf of the researchers and authors: “The independent predictors of compliance revealed in the study are noteworthy. The fact that the level of education is a significant predictor for compliance not only in metabolic evaluation but also in diet adherence is an important finding. This suggests that educational strategies could play a vital role in improving patient compliance.”

“Additionally, the link between the type of patient care received and compliance rates is intriguing, as it underscores the potential impact of patient care in dedicated stone clinic or not on patient outcomes.”

Patient compliance for calcium-oxalate stones had not been examined extensively before, a defect the eCORE group wanted to correct in order to develop new strategies to improve compliance. Prof. Güven speculates on several contributing factors for this notable gap in the existing literature:

Prof. Güven: “The Castor database is a platform that allows for the standardised collection, management, and analysis of research data across various studies and clinical trials. This enables researchers to conduct multi-centre studies with consistent data collection methods, enhancing the quality and reliability of the research.”

The Research Foundation prepared the database specifically for the CoMET project. This laid the foundations for the eCORE researchers to start compiling their patient data. CoMET is the first EAU RF-supported project to use Castor. It is also so far the only patient survey to be supported in this way, other upcoming projects for which the Research Foundation will be using Castor areclinical registries.

According to Prof. Güven, the study raises several potential topics for further research in patient compliance: “The scope for further research is broad and could include interventions designed to improve compliance, such as patient education programmes tailored to varying levels of literacy and understanding. Investigating the efficacy of specialised stone clinics in enhancing compliance, as well as exploring the psychological and socioeconomic factors that contribute to compliance, would also be valuable. Longitudinal studies could offer insight into how compliance changes over time and the effectiveness of different interventions. Moreover, exploring the role of digital health tools in supporting patient adherence to treatment plans could be an innovative area of research.”


Gökce, M.İ., Güven, S., Petkova, K. et al. Patient compliance for metabolic evaluation and medical treatment (CoMET) in calcium-oxalate stone patients: prospective study by EULIS eCORE study group. World J Urol (2023).

“CoMET is the first EAU RF-supported project to use Castor. It is also so far the only patient survey to be supported in this way…”

“Historically, there might have been a greater focus on acute treatment and immediate outcomes rather than long-term management and prevention. Additionally, the intermittent nature of stone disease with variable intervals of recurrence might lead to challenges in longitudinal compliance studies. It’s also possible that until recently, there has been insufficient infrastructure for large-scale, multi centre studies to track compliance over time and across diverse patient populations.”

EAU RF Support

The study was aided by the use of the online platform Castor, with access provided and prepared by the EAU Research Foundation for the eCORE researchers.