Asymptomatic Renal Stones Research Articles

Is traditional stone clinic the optimal use of NHS resources?

There is no clear guidance on the efficacy of stone follow-up. NICE have been unable to make recommendations with current published evidence. The aim of this study was to understand the patient journey resulting in surgical intervention, and whether traditional stone follow-up is effective. A retrospective review of patients undergoing ureteroscopy (URS) or percutaneous nephrolithotomy (PCNL) over a 3year period identified 471 patients who underwent these procedures to treat stone disease. Records were interrogated for the following: symptoms, mechanism of booking, reason for intervention, stone size, stone location, risk factors and previous follow-up. Of 471 patients who underwent intervention, 168 were booked from stone clinic follow-up (36%). Of these, 96% were symptomatic and 4% were asymptomatic. When risk factors were removed, this figure was reduced to 1%. Sepsis rate for emergency admissions differs between those followed up (13%) versus new presentations (19)%. There was no statistically significant difference in the outpatient imaging frequency between patients booked from an emergency admission (80% having imaging every 6months) and those from the clinic (82%). Our Hospital provides on average 650 stone clinic appointments a year with a cost of £93,000. Given the low rate of intervention in patients with asymptomatic renal stones, a symptomatic, direct-access emergency stone clinic could be a better model of care and use of NHS resources. Urgent research is required in this area to further assess if this is the case.

MP23-11 REMOVAL OF SMALL ASYMPTOMATIC RENAL STONES TO REDUCE RELAPSE

You have accessJournal of UrologyCME1 Apr 2023MP23-11 REMOVAL OF SMALL ASYMPTOMATIC RENAL STONES TO REDUCE RELAPSE Mathew D. Sorensen, Jonathan D. Harper, Michael S. Borofsky, Tariq A. Hameed, Kimberly J. Smoot, Barbara H. Burke, Branda J. Levchak, James C. Williams, Ziyue Liu, Michael R. Bailey, and James E. Lingeman Mathew D. SorensenMathew D. Sorensen More articles by this author , Jonathan D. HarperJonathan D. Harper More articles by this author , Michael S. BorofskyMichael S. Borofsky More articles by this author , Tariq A. HameedTariq A. Hameed More articles by this author , Kimberly J. SmootKimberly J. Smoot More articles by this author , Barbara H. BurkeBarbara H. Burke More articles by this author , Branda J. LevchakBranda J. Levchak More articles by this author , James C. WilliamsJames C. Williams More articles by this author , Ziyue LiuZiyue Liu More articles by this author , Michael R. BaileyMichael R. Bailey More articles by this author , and James E. LingemanJames E. Lingeman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003248.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The benefit of endoscopically removing small (≤6 mm) asymptomatic renal stones is unknown. AUA guidelines leave the decision to the urologist and patient. A prospective study with shock wave lithotripsy and some retrospective studies favor observation. However, several studies quoted in AUA guidelines show about half of small renal stones cause a stone event within 5 years. We performed a randomized, controlled trial (ClinicalTrials.gov number, NCT02210650) of removing small asymptomatic renal stones at the time of ureteral or contralateral stone surgery and hope to discuss the results with the AUA community. METHODS: In a multi-center, randomized, controlled trial, 38 patients had their small asymptomatic renal stones removed, and 35 patients (Control group) did not, during endoscopic removal of ureteral or contralateral renal stones. The primary outcome was relapse measured by future emergency department (ED) visits, surgeries, and stone growth. RESULTS: After a mean follow up duration of 4.2 years, the Treatment group had longer relapse time than the Control group (p<0.0001, logrank test). The restricted mean time-to-relapse was 75% longer in the Treatment group (1631.6 (standard error 72.8) days vs. 934.2 (121.8)). Relapse risk was 82% lower in the Treatment group (hazard ratio 0.18, 95% confidence interval 0.07-0.44) with 16% vs. 63% of subjects relapsing. Treatment added a median of 25.6 (interquartile range 18.5-35.2) minutes to surgery. ED visits within 2 weeks of surgery were 5 in the Treatment group and 4 in the Control group. Eight Treatment and 10 Control subjects reported passing stones. CONCLUSIONS: Removal of small, asymptomatic renal stones during surgery for ureteral or contralateral renal stones reduced relapse. Treatment increased surgery duration but did not increase surgical returns to the ED or passing stones. As surgical tools and techniques continue to improve, the balance may further tilt toward early intervention. Source of Funding: Supported by NIH NIDDK grant P01 DK043881 and from resources through the Veterans Affairs Puget Sound Health Care System © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e310 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mathew D. Sorensen More articles by this author Jonathan D. Harper More articles by this author Michael S. Borofsky More articles by this author Tariq A. Hameed More articles by this author Kimberly J. Smoot More articles by this author Barbara H. Burke More articles by this author Branda J. Levchak More articles by this author James C. Williams More articles by this author Ziyue Liu More articles by this author Michael R. Bailey More articles by this author James E. Lingeman More articles by this author Expand All Advertisement PDF downloadLoading ...

Ex vivo removal of stones in donor kidneys by pyelotomy prior to renal transplantation: a single-center case series

BackgroundDonors with incidentally discovered asymptomatic renal stones was considered a relative contraindication to the kidney donation because of a potential increased morbidity risk for renal transplant recipients. Stone clearance from the donors should be done before donation to ensure safety of the recipient. This study aimed to observe the safety and efficacy of kidney transplantation from donors with nephrolithiasis who received pyelolithotomy before transplantation.MethodsBetween January 2015 and March 2021, 14 deceased organ donors at The Second Affiliated Hospital of Guangzhou Medical University were found to have kidney stones during predonation evaluation. After donor kidney repair, all of the donor kidneys underwent ex vivo pyelolithotomy. Then the organs were transplanted to the right iliac fossa of 17 patients with end-stage renal failure. Data were analyzed for technical feasibility, intraoperative and postoperative complications, and stone clearance. Ultrasonography and urinal routine were followed at the 1-, 3-, and 6-month postoperatively.ResultsThe stones were successfully removed ex vivo by pyelotomy with an average time of 41.0±12.8 minutes. Seventeen recipients successfully underwent renal transplantation, and their renal function recovered well. Slight gross hematuria occurred in 12 cases after operation, and hematuria disappeared after conservative treatment. Ureteral stents were removed within two months after the procedure. There were no complications such as delayed recovery of renal function, acute rejection, ureteral necrosis, and urinary fistula. The serum creatinine of 17 patients 1 month after the operation was 136.8±26.7 µmol/L. None of the 17 patients included in the study suffered from stone recurrence or graft dysfunction in the follow-up period.ConclusionsEx vivo removal of stones by pyelotomy was a technically feasible means of safely and efficiency rendering a stone-bearing donor kidney stone-free. The procedure obtained good early-middle outcomes in kidney transplantation and is therefore worthy of clinical application.

UP25 - Decision making, preference and treatment choice for asymptomatic renal stones – Balancing benefit and risk of observation and surgical intervention: A real-world survey using social media (SoMe) platform.

UP25 - Decision making, preference and treatment choice for asymptomatic renal stones – Balancing benefit and risk of observation and surgical intervention: A real-world survey using social media (SoMe) platform.

Consensus Statement on Urinary Stone Treatment During a Pandemic: A Delphi Process from the Endourological Society TOWER Research Initiative.

Introduction: The novel coronavirus disease (COVID-19) pandemic has had a significant impact on the care of patients with urolithiasis. Recommendations and prioritization of endourologic surgical procedures vary among regions, and a comprehensive overall international directive is needed. We used the Delphi method to obtain international consensus on managing urolithiasis patients during the pandemic. Methods: A three-round Delphi process was used to elicit expert consensus (53 global key opinion leaders within the Endourological Society from 36 countries) on an extensive survey on management of endourologic patients in a pandemic. Questions addressed general management, inpatient and outpatient procedures, clinic visits, follow-up care, and best practices for suspension and resumption of routine care. Results: Consensus was achieved in 64/84 (76%) questions. Key consensus findings included the following: consultations should be delivered remotely when possible. Invasive surgical procedures for urolithiasis patients should be reserved for high-risk situations (infection, renal failure, etc.). To prevent aerosolization, spinal anesthesia is preferred over general, whenever feasible. Treatment of asymptomatic renal stones should be deferred. Primary definitive treatment of obstructing or symptomatic stones (both renal and ureteral) is preferred over temporizing drainage. Extracorporeal shockwave lithotripsy should be continued for obstructive ureteral stones. There was consensus on treatment modalities and drainage strategies depending on location and size of the stone. Conclusion: International endourologist members of the Endourological Society participated in this Delphi initiative to provide expert consensus on management of urolithiasis during a pandemic. These results can be applied currently and during a future pandemic.

Predictors of Stone-Related Events in Asymptomatic Untreated Intrarenal Calculi.

Purpose: There is a lack of data on the natural history of asymptomatic intrarenal calculi. In this study, we investigate stone-related events (SREs) in patients with untreated intrarenal calculi. We also investigate predictive factors for SREs. Methods: All patients found with an asymptomatic intrarenal calculus on CT kidney, ureter, bladder managed conservatively with interval imaging for ≥6 months were included. Patients were evaluated for any SRE. The rate of event according to calculus size, location, and number of calculi was also analyzed. Multivariate logistic regression analysis was performed to determine significant predictors for SREs. Results: In total, 266 renal units from 177 patients met inclusion criteria. The mean stone size was 4.44 mm (range 1-25 mm). Duration of follow-up was 43.78 ± 26.86 months (range 6-106 months). The overall rate of SREs, including intervention (n = 80) and spontaneous stone passage after ureteral colic (n = 40), was 45.1% (n = 120/266). Stones >5 mm were more likely to lead to an event compared with stones ≤5 mm (odds ratio [OR]: 2.94; p = 0.01). Interpolar stones and stones located in multiple calices were more likely to cause a SRE than lower pole stones (OR: 2.05; p = 0.05 and OR: 2.29; p = 0.03, respectively). Conclusion: In this large series of patients with asymptomatic intrarenal calculi, the incidence of a spontaneous SRE was 45.1% after 41 months. Stone size and stone location were significant predictors for a SRE. Information from this study will enable urologists to accurately risk stratify patients with asymptomatic renal stones.

Clinical characteristics of surgically managed patients with asymptomatic renal stones: Comparison of patients with symptomatic renal stones.

This study aimed to compare the characteristics of asymptomatic and symptomatic nephrolithiasis in patients who underwent surgical treatment for kidney stones. Between 2015 and 2019, 245 patients who underwent percutaneous nephrolithotomy or retrograde intrarenal surgery for kidney stones were included. The patients were divided into asymptomatic (n=124) and symptomatic (n=121) groups. All patients underwent blood and urine tests, preoperative non-contrast computed tomography, and postoperative stone composition analysis. We retrospectively analyzed and compared the characteristics of the patients and stones, operation time, stone-free rate, and postoperative complications between the two groups. In the asymptomatic group, mean body mass index (BMI) was significantly higher (25.7±3.8 kg/m² vs. 24.3±2.8 kg/m², p=0.002) and urine pH was significantly lower (5.6±0.9 vs. 5.9±0.9, p=0.013). The ratio of calcium oxalate dihydrate stones was significantly higher in the symptomatic group (5.3% vs. 15.5%, p=0.023). No significant differences were observed in stone characteristics, postoperative outcomes, or complications. In the multivariate logistic regression analysis for predicting variables for asymptomatic renal stones, BMI (odds ratio [OR], 1.144; 95% confidence interval [CI], 1.038-1.260; p=0.007), and urine pH (OR, 0.608; 95% CI, 0.407-0.910; p=0.016) were independent predictive variables for asymptomatic renal stones. This study demonstrated that thorough medical check-ups are needed for the early detection of renal stones in individuals with a high BMI or low urine pH.

Decision-Making, Preference, and Treatment Choice for Asymptomatic Renal Stones-Balancing Benefit and Risk of Observation and Surgical Intervention: A Real-World Survey Using Social Media Platform.

Introduction: The burden of kidney stone disease has risen, and several treatment options now exist. We wanted to evaluate the preference and treatment choices based on the information provided for management of hypothetical 8 and 15 mm renal stone, and factors that influenced their decision. Materials and Methods: An online questionnaire to investigate trends in decision-making for two hypothesized scenarios of asymptomatic kidney stones (8 and 15 mm) was formatted online in Microsoft Forms and posted on social media (Facebook) in Europe. The ethical approval was obtained from the University Ethics Committee, and data were collected from general public between September and November 2020. Results: A total of 476 participants of different age and background answered the survey with a male:female ratio of 1:2.7. The age groups were categorized as 18-25 years (n = 149), 26-49 years (n = 192), and 50+ years (n = 135). In the 8 mm scenario, 107 of the 476 participants (22.5%) chose observation, 249 (52.3%) chose extracorporeal shockwave lithotripsy (SWL) and 120 (25.2%) opted for ureteroscopy (URS). In the 15 mm scenario, 194 participants chose SWL treatment (40.8%), 216 (45.4%) URS, and 66 (13.9%) preferred percutaneous nephrolithotomy. The influencing factors were success rate, complication risk and invasiveness of the procedure. On comparison to 8 mm stone, while stent avoidance and activity limitation were considered less important with 15 mm stone (p < 0.001), complication rates were considered more important (p < 0.001). Conclusion: More than one treatment choice for kidney stones often exists and clinicians must take patient choice into account via an informed decision-making process. While some might accept a higher risk of invasiveness and complications for higher stone-free rate, others might have a more conservative approach to this. It is about time that urologists take patient priorities and concerns into account and perhaps use Patient Reported Outcome Measures in addition to clinical outcomes when comparing treatment success.

Natural history of small asymptomatic kidney and residual stones over a long-term follow-up: systematic review over 25 years.

To systematically review the natural history of small asymptomatic kidney and residual stones, as the incidental identification of small, asymptomatic renal calculi has risen with increasing use of high-resolution imaging. We reviewed the natural history of small asymptomatic kidney and residual stones using the Cochrane and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. We searched MEDLINE, Scopus, EMBASE, EBSCO, Cochrane library and Clinicaltrials.gov using themes of 'asymptomatic', 'nephrolithiasis', 'observation', 'symptoms', 'admission', 'intervention' and similar allied terms for all English language articles from 1996 to 2020 (25 years). Inclusion criteria were studies with ≥50 patients, stones ≤10 mm, and a mean follow-up of ≥24 months. Primary outcomes were occurrence of symptoms, emergency admission, and interventions. Our literature search returned 2247 results of which 10 papers were included in the final review. Risk of symptomatic episodes ranged from 0% to 59.4%. Meta-analysis did not identify any significant difference in the likelihood of developing symptoms when comparing stones <5 mm to those >5 mm, nor those <10 mm to those >10 mm. Risk of admission varied from 14% to 19% and the risk of intervention from 12% to 35%. Meta-analysis showed a significantly decreased likelihood of intervention for stones <5 vs >5 mm and <10 vs >10 mm. Studies had variable risk of bias due to heterogeneous reporting of outcome measures with significant likelihood that observed differences in results were compatible with chance alone (Symptoms: I2 =0%, Cochran's Q = 3.09, P = 0.69; Intervention: I2 =0%, Cochran's Q = 1.76, P = 0.88). The present systematic review indicates that stone size is not a reliable predictor of symptoms; however, risk of intervention is greater for stones >5mm vs <5 mm and >10 vs <10 mm. This review will inform urologists as they discuss management strategies with patients who have asymptomatic renal stones and offer insight to committees during the development of evidence-based guidelines.

Abstract 31 - An analysis on the predictors of stone related events in asymptomatic renal stones

Abstract 31 - An analysis on the predictors of stone related events in asymptomatic renal stones

MP65-15 DOES OBSERVATION OF ASYMPTOMATIC TREATMENT-NAIVE RENAL STONES IMPAIR HEALTH-RELATED QUALITY OF LIFE? -RESULTS FROM THE NORTH AMERICAN STONE QUALITY OF LIFE RESEARCH CONSORTIUM

You have accessJournal of UrologyStone Disease: Surgical Therapy V (MP65)1 Sep 2021MP65-15 DOES OBSERVATION OF ASYMPTOMATIC TREATMENT-NAIVE RENAL STONES IMPAIR HEALTH-RELATED QUALITY OF LIFE? -RESULTS FROM THE NORTH AMERICAN STONE QUALITY OF LIFE RESEARCH CONSORTIUM Necole Streeper, Matthew Galida, Suzanne Boltz, Shuang Li, Stephen Nakada, Eric Raffin, David Brown, Vernon Pais, Justin Chan, Ben Chew, and Kristina Penniston Necole StreeperNecole Streeper More articles by this author , Matthew GalidaMatthew Galida More articles by this author , Suzanne BoltzSuzanne Boltz More articles by this author , Shuang LiShuang Li More articles by this author , Stephen NakadaStephen Nakada More articles by this author , Eric RaffinEric Raffin More articles by this author , David BrownDavid Brown More articles by this author , Vernon PaisVernon Pais More articles by this author , Justin ChanJustin Chan More articles by this author , Ben ChewBen Chew More articles by this author , and Kristina PennistonKristina Penniston More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002105.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Detection of asymptomatic non-obstructing renal stones are increasingly prevalent as an incidental finding. We are then faced with the decision to treat or not to treat, knowing there is potential for future symptomatic stone episodes. In this study we evaluated whether patients with asymptomatic, treatment naïve renal stones have impaired health-related quality of life (HRQOL) using the Wisconsin Stone Quality of Life (WISQOL) questionnaire. METHODS: With IRB approval, 259 adult patients with a history of kidney stones at 4 centers completed the WISQOL questionnaire. We retrospectively reviewed imaging to evaluate for non-obstructing renal stones, and whether these were residual fragments from surgical intervention or treatment naïve. We calculated standardized WISQOL total and domain scores (0-100), including social functioning (D1), emotional functioning (D2), stone-related impact (D3) and vitality (D4). Scores were compared between patients with treatment naïve stones to those who were stone-free and to those with residual fragments after surgical intervention. RESULTS: Demographics did not differ between groups: mean age 54.4 ± 13.2 and 53.1% female. The average stone size for the treatment naïve group was 7.23 ± 6.43 mm. There was no significant difference in total WISQOL score for patients with treatment naïve renal stones (n=116) compared to patients that were stone-free (n=104), 80.6 ± 19.8 vs 82.2 ± 18.8 respectively, (p=0.57). When patients with treatment naïve stones were compared to those with residual stone fragments after surgical intervention (n= 39), there was no significant difference in total WISQOL score (p = 0.29). In addition, there was no significant difference for individual domain scores. CONCLUSIONS: Preliminary evidence suggests that observation of asymptomatic treatment naïve renal stones offers equivalent HRQOL to patients with residual fragments and those who are stone free. These results support that in a properly counseled patient, surveillance of asymptomatic non-obstructing renal stones is an acceptable management strategy. Source of Funding: none © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1125-e1125 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Necole Streeper More articles by this author Matthew Galida More articles by this author Suzanne Boltz More articles by this author Shuang Li More articles by this author Stephen Nakada More articles by this author Eric Raffin More articles by this author David Brown More articles by this author Vernon Pais More articles by this author Justin Chan More articles by this author Ben Chew More articles by this author Kristina Penniston More articles by this author Expand All Advertisement Loading ...

Informing the Management of Asymptomatic Nephrolithiasis: Markov Decision Analysis for the 1 cm Renal Stone.

The management of an incidentally discovered, asymptomatic renal stone includes watchful waiting, shock wave lithotripsy, ureteroscopy with basket extraction of fragmented stones (URS-B) or ureteroscopy with laser "dusting" (URS-D). Each intervention has varying stone-free rates, requirements for ureteral stenting, and variable impact on a patient's quality of life. Decision analysis was used to assess the optimal quality adjusted life-years associated with each treatment option. A Markov model was constructed to represent potential outcomes for a single 1 cm renal stone after treatment. The cohort was followed for 1-month cycles over 3 years and toll penalties for receiving a stent and undergoing surgery were standardized and incorporated into each subtree. Probabilities, utilities and toll penalties were derived from existing literature or clinical extrapolation when no published data were available. One-way sensitivity analyses were performed to determine threshold probabilities/utilities that may alter preferred options. Watchful waiting was the preferred intervention, preserving 2.82 quality adjusted life-years over 3 years. The remaining options had similar but decreasing quality adjusted life-years: URS-B provided 2.78 quality adjusted life-years; shock wave lithotripsy provided 2.72 quality adjusted life-years, and URS-D provided 2.67 quality adjusted life-years. One-way sensitivity analysis showed that URS-D was preferred when stone-free rates from URS-B dropped below 37%. Shock wave lithotripsy was preferred over URS-B when stone-free rates from URS-B dropped below 62%. As stents became progressively less bothersome, watchful waiting is preferred, followed by URS-B, shock wave lithotripsy and URS-D. Watchful waiting is the preferred management decision for asymptomatic renal stones. However, these results are sensitive to both actual stone-free rate and individual stent tolerance.

Should Asymptomatic Renal Stones Be Surgically Treated? Pro-Observation.

N/A.

Should Asymptomatic Renal Stones Be Surgically Treated? Pro Treatment.

n/a.

ASYMPTOMATIC DONOR STONES: MANAGEMENT ALGORITHM

Introduction: Kidney transplantation in India is largely a live donor program. With incorporation of Computed Tomogram Angiography (CTA) during donor workup, significant number of renal stones are diagnosed. Herein, we present our experience and management algorithm of asymptomatic donor kidney stones. Materials and Methods: We retrospectively reviewed all donor and recipient files of transplants done between April 2013 and September 2018 done in our institute. All records of donors diagnosed with asymptomatic renal stones were analyzed for demography, stone size, metabolic workup, intraoperative management and follow up. Recipient follow up records were evaluated for any stone related event including surgical intervention. Our algorithm of asymptomatic donor stone management is as depicted in Figure 1.Results: Between April 2013 and September 2018, 1083 transplants were done. Follow up of 827 patients could be retrieved from hospital electronic health record (EHR). The results described in Figure 2. We do not use Ho LASER to fragment stones due to risk of injury to avascular graft kidney. No recurrence was seen in donors.Conclusion: Donors with asymptomatic stones could be safely accepted, provided metabolic workup is negative. We believe our algorithm is a practical and safe approach to deal with asymptomatic donor stones.

The Natural History of Asymptomatic Renal Stones ≤5 mm: Comparison with ≥5 mm

Objectives: To clarify the natural history of asymptomatic renal stones ≤5 mm in comparison with stones ≥5 mm. Calculi ≤5 mm are considered insignificant stones, but to what extent stone-related events can occur is unclear. Patients and Methods: In this retrospective study, 207 patients with asymptomatic renal stones confirmed by both CT and ultrasonography performed on the same day were enrolled. A follow-up ultrasound was performed every 6 months. The active indications for surgical intervention included stone relocations into the ureter and stone-related symptoms. The primary endpoint was the rate of surgical intervention. Results: A total of 207 patients (71 cases with stones ≤5 mm and 136 cases with stones >5 mm) were included in this study. At a median follow-up of 3.3 years, 14 patients (20%) from the ≤5-mm group and 52 (38%) from the >5-mm group underwent surgical treatment (p = 0.0067). Moreover, 11 patients (16%) from the ≤5-mm group and 27 (20%) from the >5-mm group received surgical intervention as they manifested active indications, showing no significant difference (p = 0.44). As regards stone events, there were no significant differences in spontaneous stone passage, pain, hematuria, and stone growth. Multivariate analysis revealed that age ≤50 years and a history of stone surgery were significant factors, but stone size was not. Conclusion: About 20% of asymptomatic renal stones ≤5 mm require surgical treatment within 5 years.

MP03-02 INFORMING THE MANAGEMENT OF ASYMPTOMATIC NEPHROLITHIASIS

INTRODUCTION AND OBJECTIVE:The management of incidentally discovered, asymptomatic renal stones is controversial. Options include watchful waiting (WW) or pre-emptive surgical treatments. Shock wav...

Urologic treatment of nephrolithiasis.

The purpose of this review is to describe the options and recent developments in the urologic treatment of nephrolithiasis in children. The prevalence of nephrolithiasis in children has increased over time. The urologic treatment of nephrolithiasis ranges from observation to medical expulsive therapy with an alpha blocker for a stone in a ureter to a variety of procedures for stone removal. Observation for small, asymptomatic renal stones is a reasonable strategy in children. Medical expulsive therapy with an alpha blocker may have a beneficial effect for passage of ureteral stones in children. Extracorporeal shock wave lithotripsy (ESWL) remains an important treatment for nephrolithiasis in children. Advances in ureteroscopy with clearer digital imaging and single use ureteroscopes have made ureteroscopy more attractive. Percutaneous nephrolithotomy is a more invasive treatment modality but remains a good choice for children with large-stone burdens and instruments are getting smaller. Open or laparoscopic stone surgery should be reserved for unique cases. Nephrolithiasis is increasing in children with differing urologic management options depending on the clinical scenario. A shared decision-making process with discussion of risks and benefits should be used to help patients and families choose a treatment option.

Current aspects in pediatric urolithiasis treatment

Compared with adults, urolithiasis is quite rare in children (1-2% of all urinary stones occur during childhood). In principle, all therapy modalities for adults can also be used in children. However, due to some anatomic and functional peculiarities in children, the differential indication for the various treatment modalities differ. As arule, asymptomatic renal stones are not treated but observed. More urinary stones pass spontaneously in children compared with adults. If spontaneous passage is not possible or does not occur, noninvasive and minimally invasive techniques are indicated. Extracorporeal shock wave lithotripsy is the therapy of choice in most instances. Today, endoscopic techniques, however, can be safely used even in very small infants. For larger renal stones and those consisting of cysteine or whewellite, percutaneous nephrolithotomy (PCNL) is the therapy of choice, and for distal ureteral stones ureteroscopy is the method of choice. Laparoscopic and open surgery are reserved for very rare cases, especially with concomitant pathologies. Bladder calculi are treated by transurethral or suprapubic lithotripsy.

Re: Outcomes of Long-Term Follow-up of Asymptomatic Renal Stones and Prediction of Stone Related Events.

Re: Outcomes of Long-Term Follow-up of Asymptomatic Renal Stones and Prediction of Stone Related Events.