The Durability of Active Surveillance in Patients with Asymptomatic Kidney Stones: A Systematic Review

Han, David; Cher, Benjamin A Y; Lee, Dong Hoon; Rajendran, Sreevaishali; Riblet, Natalie; Pais, Vernon M.

doi:10.1089/end.2018.0695

Cited by 20 publications

(11 citation statements)

References 23 publications

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“…[20][21][22] Several studies have reported factors associated with surgical intervention during active surveillance, including male sex, age (£50 years), the rate of stone growth, stone history, and stone size. 3,5,7,15,17 In this study, age £50 years and a history of surgical intervention were significant factors associated with surgical intervention, but not stone size <5 mm. Interestingly, in the present study, the incidence of surgical intervention was low in patients above 50 years of age with asymptomatic renal stones £5 mm and without a history of surgical intervention.…”

Section: Discussionmentioning

confidence: 50%

“…There was little evidence on the clinical course of asymptomatic renal stones, but several recent studies have reported the natural history of asymptomatic renal stone patients who had undergone active surveillance. 5,7 However, these studies had limitations, including small sample size, short follow-up period, and inconsistency of imaging modalities. In particular, the data about the natural history of calculi £5 mm are very limited.…”

Section: Introductionmentioning

confidence: 99%

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

Kanno

Takahashi

Ito

et al. 2020

Journal of Endourology

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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.

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Section: Discussionmentioning

confidence: 50%

Section: Introductionmentioning

confidence: 99%

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

Kanno

Takahashi

Ito

et al. 2020

Journal of Endourology

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“…The present systematic review adds to the previous review, which did not have strict inclusion criteria based on size but did report wide variation in rates of symptoms and intervention, as we have also highlighted [43]. The present review was prospectively registered with PROSPERO for transparency of data collection and reporting of outcome measures, which was based on large studies with a long‐term follow‐up of small stones, an area that poses the greatest uncertainty in KSD management [44].…”

Section: Discussionmentioning

confidence: 93%

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

et al. 2021

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Objective 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. Materials and methods 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. Results 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). Conclusions 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.

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“…For better stratification of patients and more personalized management, each of these factors should be analyzed. Management options are active surveillance, medical expulsive therapy, chemolysis or surgical intervention with a rate that vary from 7 to 27% [ 3 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

Urologists are optimistic surgeons: prevalence and predictors of discordance between intraoperative stone-free rate and cross-sectional imaging evaluation after vacuum-assisted mini-percutaneous nephrolithotomy

et al. 2022

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Purpose To assess how accurate are urologists in predicting stone-free status (SFS) after vacuum-assisted mini-PCNL (vamPCNL) compared to computed tomography (CT) and clinical predictors of discordant SFS. Methods Data from 235 patients who underwent vamPCNL were analysed. Patient’s demographics, stones’ characteristics and operative data were recorded. SFS was evaluated intraoperatively by the treating urologist (iSFS) and with non-contrast CT 3 months after vamPCNL (ctSFS). SFS was defined as no residual stones. Stone complexity was scored with the Guy’s score. Descriptive statistics and logistic regression models were used to identify clinical factors associated with discordant SFS (namely iSFS not confirmed at CT). Results iSFS and ctSFS were 88.5% and 65.5%, respectively, with 54 (23%) cases resulting in discordant evaluation of SFS between the surgeon and CT imaging. Patients with discordant SFS had larger stone volume (p < 0.001), higher rate of multiple stones (p = 0.03) and higher rate of multiple calyceal groups affected by stones (p < 0.001) than those with concordant SFS. The use of flexible ureteroscopes to look for residual stones after lithotripsy was more frequently reported in cases with concordant SFS (p = 0.001). Multivariable logistic regression analysis revealed that stones in > 2 calyceal groups (OR 10.2, p < 0.001), Guy’s score II (OR 5.8, p < 0.01) and not using flexible ureteroscopes after lithotripsy (OR 2.9, p = 0.02) were independent predictors of discordant SFS. Conclusion One out of five patients is erroneously considered SF after vamPCNL. Urologist should carefully evaluate patients with multiple calyceal stones and consider using flexible ureteroscopes to complete lapaxy of migrated fragments in order to improve their prediction of SFS.

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The Durability of Active Surveillance in Patients with Asymptomatic Kidney Stones: A Systematic Review

Cited by 20 publications

References 23 publications

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

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

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

Urologists are optimistic surgeons: prevalence and predictors of discordance between intraoperative stone-free rate and cross-sectional imaging evaluation after vacuum-assisted mini-percutaneous nephrolithotomy

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