Role of conservative management of stones.

Abstract

Urinary tract stone disease is one of the most common pathologies of the modern era with a rising prevalence owing to incidentally detected renal stones from imaging for other reasons. Although there is consensus on active management of symptomatic and asymptomatic stones in high-risk patient groups, conservative management of stones is still controversial. We have reviewed the literature pertaining to conservative management of 3 groups of stones-asymptomatic calyceal stones, staghorn stones, and ureteric stones-and summarized the findings to provide guidance in the conservative management of stones. In the calyceal stone group, our review showed an average spontaneous stone passage rate of 18% (range, 8%-32%) and an average requirement for surgical intervention of 20% (range, 7%-40%), with 62% of patients remaining safely on surveillance over a mean time of 4 years. In the staghorn group, overall disease-specific mortality was noted to be 16% (range, 0%-30%) and chance of renal deterioration was 21% (range, 0%-34.5%), with a mean incidence of infection of 22%. In case of conservatively managed ureteric stones, the rate of spontaneous passage for stones smaller than 5 mm was 75%, compared with 62% for those larger than 5 mm. Based on the position in the ureter, spontaneous passage rates were 49%, 58%, and 68% for proximal, middle, and distal thirds, respectively. Conservative management may be recommended for asymptomatic patients and those who are deemed unfit for any procedures. However, careful patient selection and thorough counseling about the risks of conservative management could make it a suitable option for an appropriate subset of patients.