Core Concepts
Active surveillance is a viable option for asymptomatic kidney stones.
Abstract
Dr. Kevin Stritt presented findings at the American Urological Association (AUA) 2023 Annual Meeting regarding the natural history of asymptomatic renal stones. The NOSTONE trial assessed the efficacy of hydrochlorothiazide in preventing recurrence in patients with recurrent calcium-containing kidney stones. Key points include:
- 39% of kidney stone passages were asymptomatic.
- Asymptomatic stones were a median size of 2.4 mm.
- Patients with stones less than 2 mm have a high chance of passing them in about 8 days.
- Urologists can consider active surveillance for small stones but may opt for more aggressive management for larger stones.
- Dehydration and specific diets contribute to the increasing incidence of kidney stones.
- Patients with a history of stones have a high risk of recurrence.
Stats
"39% (158) were asymptomatic stone passages" - Dr. Kevin Stritt
"52% are likely to develop symptoms" - Dr. Ephrem Olweny
"Patients with a history of stones have a 50% risk of recurrence in the next 5 years" - Dr. David Schulsinger
Quotes
"Observation should be initially offered to these patients. However, patients should be informed that 52% are likely to develop symptoms, and some may indeed opt for pre-emptive surgical removal." - Dr. Ephrem Olweny
"But if a patient has a 7- or 8-mm stone, you might be more inclined to manage that patient a little bit more aggressively." - Dr. David Schulsinger