Natural History of Asymptomatic Renal Stones.

[Argirios Argiriou]

April 23, 2015

Allan S. Brett, MD reviewing Dropkin BM et al. J Urol 2015 Apr.

During average follow-up of 3.5 years, 28% of stones became symptomatic.

Asymptomatic renal stones often are found incidentally on abdominal imaging done for unrelated reasons or during evaluation of patients with symptomatic passage of ureteral stones. In this retrospective study from a single U.S. urological practice, researchers examined the natural history of 160 asymptomatic renal stones (mean size, 7 mm) in 110 adults. Most patients (87%) had experienced previous symptomatic ureteral stones. Patients underwent routine renal ultrasound imaging every 6 to 12 months.

During average follow-up of 3.5 years, 45 stones (28%) became symptomatic, and 27 of them required intervention. Additionally, 3 stones caused painless silent hydronephrosis that resulted in intervention. About 20% of stones grew in diameter by >50%, but stone growth was not associated with development of symptoms. Stones located in the lower pole of the kidney were significantly less likely to become symptomatic than mid-kidney or upper-pole stones (24% vs. 41%).

COMMENT

This study doesn't tell us whether routine serial imaging (done by these urologists) is justified for all patients with asymptomatic renal stones or whether selected patients with asymptomatic stones should undergo prophylactic invasive intervention. But the study does give us an idea of the natural history of asymptomatic stones — information that can be shared with patients. One caveat: We don't know whether one can extrapolate from this series (in which nearly all patients had experienced previous symptomatic stones) to patients with no history of symptomatic stones.

EDITOR DISCLOSURES AT TIME OF PUBLICATION

Disclosures for Allan S. Brett, MD at time of publication
Nothing to disclose
CITATION(S):

Dropkin BM et al. The natural history of nonobstructing asymptomatic renal stones managed with active surveillance. J Urol 2015 Apr; 193:1265. (Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος)